Study Finds High Utilization of Neuroimaging for Headaches Despite Guidelines

Bottom Line: Neuroimaging for headaches is frequently ordered by physicians during outpatient visits, despite guidelines that recommend against such routine procedures.

Author: Brian C. Callaghan, M.D., M.S., of the University of Michigan Health System, Ann Arbor, and colleagues.

Background: Most headaches are due to benign causes, and multiple guidelines have recommended against routine neuroimaging for headaches.

How the Study Was Conducted: The authors analyzed National Ambulatory Medical Care Survey data for all headache visits for patients 18 years or older from 2007 through 2010.

Results: There were 51.1 million headache visits during those four years, including 25.4 million for migraines. Neuroimaging was performed in 12.4 percent of all headache visits and in 9.8 percent of migraine visits at an estimated cost of $3.9 billion. The use of neuroimaging has increased from 5.1 percent of all annual headache visits in 1995 to 14.7 percent in 2010.

Discussion: “Since 2000, multiple guidelines have recommended against routine neuroimaging in patients with headaches because a serious intracranial pathologic condition is an uncommon cause. Consequently, the magnitude of per-visit neuroimaging use found in this study suggests considerable overuse.” (JAMA Intern Med. Published online March 17, 2014. doi:10.1001/jamainternmed.2014.173