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Brain Scans for Headache: Unnecessary, Overused & Too Costly?

Even though no telltale signs of migraine show up in brain scans, they are usually part of the workup when someone first sees a doctor for head pain. MRIs and CT scans are not used to confirm a migraine diagnosis, but to rule out a life-threatening one, like a brain tumor or aneurysm.

Only a tiny percentage of headaches have an underlying issue that can be detected on a scan, but $1 billion each year is spent in the U.S. on scans for headache, according to a study published in JAMA Internal Medicine this week. The study also found that the frequency of brain scans for headache is on the rise.1

These findings contradict the guidelines that the American College of Radiology issued in 2012, which caution against brain scans for headaches unless a patient has specific risk factors or symptoms indicative of problems like a brain tumor or stroke. This recommendation is in part to reduce medical spending, but also to protect patients from radiation exposure and the battery of tests and worry that will ensue if the scan turns up a false positive.

Avoiding unnecessary radiation and unnecessary medical tests (and expenses) is logical and wise, but what about patients who are terrified that their headaches are indicative of a life-threatening condition?

We’re conditioned to think that severe, disabling headaches are the result of a brain tumor (even though they almost never are). In the absence of blood tests or scans to prove a person has migraine, patients often worry that their doctors missed something and migraine was the wrong diagnosis. MRIs or CT scans may be unnecessary, but they give patients peace of mind.

Is peace of mind the best use of medical tests and health care dollars? No, not rationally. So, tell me, how often does rationality come into play when someone thinks their life (or brain) is at stake?

Headache accounts for a quarter of all doctor visits. Some may take this to mean that headache is a common malady that’s no big deal. That belief is the very reason that headache accounts for so many trips to the doctor — people tend to think that the only time head pain is disruptive or disabling is because it’s indicative of a brain tumor or something else life threatening.

Despite experts’ recommendations and studies showing massive amounts of money spent on tests that show nothing is wrong, brain scans will continue to be used for headache until people understand that “no big deal” and “going to kill you” aren’t the only two types of headaches.

In my early days of diagnosis, I couldn’t rest without seeing visible proof that a brain tumor wasn’t causing my debilitating head pain. I’m pretty sure I’m in the majority. How about you? Have you had imaging done for migraine? Would you have accepted your diagnosis without it?

(Curious when imaging is recommended for headache? Check the American Headache Society’s guidelines.)

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. Headaches and Neuroimaging: High Utilization and Costs Despite Guidelines. JAMA Internal Medicine. Published March 17, 2014. https://archinte.jamanetwork.com/article.aspx?articleid=1835347

Comments

  • Bobbie
    5 years ago

    I have had migraines since the age of 12. I have had Ct’s and MRI’s. For years I was told my tests were negative. It wasnt until I saw an out of state doctor, that I learned my Mri’s had shown 3 black spots on the left base of the brain. As a nurse, I got fed up with being told everything is normal. I told the doctor, I am sorry, but I know there is something going on, just because of the way I felt, and all of the neuro deficets I experience. Those 3 black spots were signs of migraine strokes. Even though this is a livable find, it just made me feel better that I was not losing my mind. It is similar to people that have PVC’s on their EKG. It is something you can live with, without being in any danger. I am Pro MRI as CT’s do not show any great details in diagnosing brain disorders or Migraines. Also,get your Carotid dopplers and forget the Ct’s. My own opinion.

  • Carl
    5 years ago

    Like you Kerrie I wanted to rule out any serious issues. I got an MRI and believe it was worth it (all clear btw). Despite what the stats say, I personally know 2 people that had migraines from other serious complications. Furthermore, with what I’ve learnt about the average clinician’s general knowledge of headache related disorders. I would definitely be getting it to rule out any other issues.

    I doubt things will change much until patients can receive a much greater level of assurance and confidence from their clinicians.

  • Justanothermigraine
    5 years ago

    I got an MRI and they found a tiny tumor on my pituitary gland. Now they want yearly mri’s to follow it. It has not grown in 8 years. The mri’s are very expensive for me. I am meeting with a Neuro surgeon soon to get another opinion on how often I need mri’s. While I’m grateful this tumor was found, the doctors do not think it has caused my migraines. They also said 20 percent of all people have these tiny tumors that do not grow. They are believed to be benign. So I am one of the 1 percent of headache mri’s that did show a brain tumor. But…it’s still not the cause of my migraines! And it may never grow or require surgery. It could be my most expensive medical problem over the next 30 years (I’m 40 now). So, I believe in mri’s for migraine but I don’t think they always help even when they find something. And my biggest beef? The messed up healthcare system that threatens to make me go bankrupt.

  • Sharon C.
    5 years ago

    On top of my migraines I am at risk for stroke. My first mri showed a cyst that is a result of forceps at birth. I don’t need yearly scans but I am closely monitored for signs of stroke.

  • MigraineSal
    5 years ago

    I think scans are critical to give a potential migraineur peace of mind and at least get rid of the ” worry ” headache, while they wait for a diagnosis. I attended my GP surgery when my head and neck pain got worse and was assured that I was not having migraines, because the pain was not one sided ( at that time ) and I was dismissed to suffer on paracetamol ! I was fortunate enough to get invited to a Migraine / Headache Workshop and found that migraines could in fact be bilateral and the Consultant who was presenting recommended that I ask my GP to refer me to his Migraine Clinic when I spoke to him at the end of the session, which I duly did.

    Thank goodness I did this because this was the turning point for me. I was very lucky in that I was an NHS ( UK ) patient on a private pathway so access to MRI’s was very easy and did not cost me personally. I had 2 MRI scans in short succession as although the head MRI proved to be clear it highlighted quite severe degeneration of the neck, which resulted in a cervical MRI weeks later. This then resulted in a diagnosis of cervical spondylotic disease with nerve entrapment at C4 and C6 and slight compression at the top of my spine, I am therefore grateful for the headaches as I would never have had the cervical MRI on the NHS and / or probably got the diagnosis, which triggers migraines.

    I forgot to mention that before getting my appointment with the Consultant Neurologist I had an emergency admission to the hospital because I had a migraine with stroke like symptoms . . . I had a head CT, which was obviously clear and I was then just discharged, with no medication, or guidance on how to manage the condition until my first appointment with my Consultant Neurologist a month later . . . not the best of care after my first very frightening hemiplegic migraine !

    I therefore feel that the MRIs have been crucial in my acceptance of the disease and understanding of how my neck issue can override the preventative meds I am on because I am now aware that I have ” 2 ” issues . . . menopausal onset migraines, which have responded well to preventative medication and flare ups of the trapped cervical nerves, which trigger migraines and which can bypass the preventative meds. Without the cervical MRI, which was only requested because of what was seen on the head MRI, I would not be armed with this invaluable information and would not have been able to research my conditions and gain such an insight into them . . . I am therefore one of the lucky ones, who is very grateful to have been given the opportunity to have the MRI’s.

  • Frajukel
    5 years ago

    I absolutely believe scans are a positive. I’ve had 2 MRI’s and a CT. My brother was one of the less fortunate who did have a brain tumor and lived only 6 months once diagnosed. Had he had his scan sooner…who knows what the outcome may have been. My first MRI for headaches was prior to my brothers diagnosis and the second was about a year after he passed away (my headache frequency & intensity had increased). It was an absolute relief to know there was no abnormality. That was also when it was determined my headaches were truly migraines. Now I know what I’m dealing with and can educate myself and learn to deal with this disease. Scans….100% in favor!!!

  • Brian in TN
    5 years ago

    Seems like this is a good application of computer diagnosis, since the odds of an initial consult with a physician experienced with migraines is virtually 0 why not have a computerized checklist of migraine symptoms to go through with the patient that would vastly reduce the number of clearly unnecessary scans, especially for the uninsured. After all a computerized checklist for suicide was found to more accurately predict attempted suicides than 90% of psychiatrists.

  • marzie
    5 years ago

    I have had 2 episodes at work where I was sent in an ambulance to the hospital. After showing definite stroke symptoms both times, they did MRI’s and brain scans. Both times, I was diagnosed with a TIA. After the second one my neurologist said that there was no signs of brain damage to my brain, and I did not have a TIA either time. In my case a MRI and scan was a good thing to be done.

  • EricP
    5 years ago

    Information on the brain aneurysm site made me question, the “billion dollars wasted” headline. http://www.bafound.org/Statistics_and_Facts

    Specifically, “Subarachnoid hemorrhage (SAH) is one of the most feared causes of acute headache upon presentation to the emergency department. Headache accounts for 1 – 2% of the emergency room visits and up to 4% of visits to the primary care offices. Among all the patients who present to the emergency room with headaches, approximately 1% has subarachnoid hemorrhage. One study put the figure at 4%.”

    So 1%-4% lives can be saved. X% don’t need to be sent because they don’t meet the criteria. That means some % are tested and nothing found. As long as the criteria is being followed, I see nothing wrong with even 99 extra CT’s for 1 saved life.

  • wendy
    5 years ago

    I’m torn on both sides. In 1990, when the migraines first began for me I was told at one point if Midrin didn’t work I didn’t have a migraine but could have a brain tumor. (No I don’t remember the dr’s name, college “heath” clinic.) Got a CT, was scared half to death. Late 90’s got the first MRI. By that time I was chronic, and while I didn’t want anything to be wrong I wanted something to be found, something tangible that could be pointed at to prove I wasn’t making this up and/or a drug addict. I got that, what I call a “better than perfect MRI,” one WML (white matter lesion). Shortly before that my migraine symptoms started to include auras and so it made sense and while it sounds scary, I haven’t noticed any changes in brain function before/since. This was found again, same one, around 10 years later. Maybe I didn’t need the last one, but unfortunately I didn’t have the films from before to show the new dr. So, I have the films from my last MRI (which is good, I have a metal place elsewhere – no MRI again soon) I don’t see the need to keep re-doing them – like other tests – without significant changes.

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