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Too Many Unneeded Brain Scans for Headaches: Study

Routine use of imaging tests not recommended, but more docs ordering them anyway, researcher says


The researchers estimated the cost of all these scans in the four-year period at $3.9 billion.

"The number-one reason physicians give is patient reassurance. It's harder to talk a patient out of it than to just get the scan," Callaghan said. "But I would argue that patient reassurance isn't worth $1 billion a year."

In addition, doctors order scans out of fear they might miss a serious condition and be sued for misdiagnosis, he noted.

The profit motive also comes into play, Callaghan added. "Facilities make a lot of money off of these tests," he said.

Patients also have a role, Callaghan said. "Imaging for headaches is on the list of tests patients should question," he said.

The report was published online March 17 as a research letter in JAMA Internal Medicine.

Guidelines from the American Academy of Family Physicians, American Academy of Neurology and the American College of Emergency Physicians recommend against routine brain scans for headache (in the absence of other indications).

The study could not verify whether scans were ordered according to guidelines or not, but showed that they occurred in the context of a headache-related visit to a doctor.

"Though this study shows levels of imaging that are undoubtedly excessive and costs that almost certainly exceed the benefits, it does not measure or discuss the benefits of brain imaging in patients with headache," said Dr. Richard Lipton, vice chairman of neurology and director of the Montefiore Headache Center at the Albert Einstein College of Medicine, in New York City.

These benefits include finding a brain tumor, stroke, brain abscess and bleeding into the brain, according to Lipton, who was not involved with the new study. Reassuring worried patients that they do not have a serious or life-threatening condition is important, he said.

In addition, scans reduce the doctor's concern that they might have missed a serious condition, as well as concerns about the liability that may arise from a failure to diagnose.

"The reality is that most headaches are benign, but distinguishing high-risk and low-risk presentations is not that easy," Lipton said. "I agree that optimizing headache brain imaging practices should be a priority."

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