In one in eight visits for headache or migraine, patients end up being sent for brain imaging.

Use your head

$1 billion a year spent on headache-related brain scans, despite guidelines to the contrary

issue 21 | Spring-Summer 2014

A patient with severe headache or migraine arrives in your office, worried her symptoms might stem from a tumor or aneurysm and asking for an MRI. What do you do? In one in eight visits for headache or migraine, patients end up being sent for brain imaging despite multiple guidelines that discourage it for most patients, a new U-M study finds. The authors, all U-M neurologists, conservatively estimate that these scans cost the U.S. about $1 billion a year.

The study, published in JAMA Internal Medicine, shows the rate of neuroimaging for headache has risen, not fallen, since guidelines were published. The authors speculate that patient demand for the scans drives this overuse. They suggest that better public education, plus insurance plans with cost sharing based on the likely value of the scan for each patient, may be needed.

The research uses national data on headache-related physician visits and neuroimaging scans by people over age 18, and calculates estimated total costs across multiple years. In all, 51.1 million headache-related patient visits occurred between 2007 and 2010 — nearly half of them related to migraine. The vast majority were by people under the age of 65, and more than three-quarters of the patients were women. In all, 12.4 percent of these visits resulted in a brain MRI or CT.

"Several guidelines — including ones from neurology and radiology groups — say we shouldn't do this, but yet we still do it a lot. This is a source of tremendous cost in health care without a lot of evidence to justify the cost," says Brian Callaghan, M.D., M.S., the U-M neurologist who led the research team.