Americans with Headaches get Excessive Brain Scans, Spending $1 Billion Annually, Study Finds

One in eight Americans that visits a doctor for a headache will end up getting a brain scan, and the habit costs about $1 billion per year, according to a new study, which suggests that many of these scans are unnecessary.

University of Michigan Medical School researchers report that the MRI and CT scans - and their associated coats - are likely not needed, given the low odds of a headache actually signifying a serious brain issue.

National guidelines for US physicians suggest that doctors don't send patients complaining of headaches or migraines for a brain scan, but the Michigan researchers reprot that the instance of brain scans for headaches has risen over the years.

Writing in JAMA Internal Medicine, the researchers report that between 2007 and 2010 there were 51 million headache-related doctors visits in the US. In those same four years, 12.4 percent of these visits resulted in a brain MRI or CT scan, with an estimated total cost of $3.9 billion, nearly $1 billion per year.

"This is a conservative cost estimate based on what Medicare would pay for these tests. CTs and MRIs are commonly ordered for headache and migraine, and increasing over time, despite the fact that there are rare circumstances where imaging should be used," said Dr. Brian Callaghan the U-M neurologist who led the team performing the study.

"Lots of guidelines say we shouldn't do this - including ones from neurology and radiology groups - 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," he said.

There are many reasons why a doctor might order a brain scan for a patient complaining of headaches, including putting the patient's mind at ease that they do not have a malignant brain tumor, aneurysm or other brain issue that is behind their symptoms.

Previous research has indicated that among patients complaining of headaches who receive brain scans, only 1-3 percent actually suffer from a growth or blood vessel problem that's responsible for the headaches.

"There's solid research showing that the number of times you find serious issues on these scans in headache patients is about the same as that for a randomly chosen group of non-headache patients," Callaghan said. "And a lot of the things we find on such scans aren't necessarily something we will do something about."

Callaghan notes that doctors rarely consider the costs of procedures and patients often have insurance that covers the cost of the scans. But he said that his research affirms the notion that most of these headache-related brain scans are unnecessary.