Headache Diagnostic Imaging









Headache is one of the most common reasons why patients schedule an appointment with their doctor. From a patient’s perspective, diagnostic imaging might appear to be the most logical and definitive way to determine the cause of headaches, but as you know, that’s usually not the case.

CT scans and MRIs are arguably an overused method for diagnosing the cause and determining the best treatment for headaches. These tests are costly, and can create more unnecessary concern.

But if a medical history and complete neurological exam reveal something more, SteleRAD’s neuroradiology specialists can help patients find relief.

What’s Behind Most Headaches

Patients who suffer from headaches often come to the natural conclusion that there’s something wrong with the brain. The next step would then be getting a clear picture of the brain to locate the problem and treat it.

Unfortunately, that’s not how most headaches work. The vast majority of headache sufferers have tension or sinus headaches.

On the surface, migraine sufferers seem to factor in higher than any others who experience headaches. But a paper written by the American Headache Society titled, “Headache Diagnosis and Testing,” gives important information about the difference between people who see their doctor, and those who don’t.

The paper compares two studies, one international and one focusing only on the US. The results were so close as to be nearly identical.

Of patients who saw their doctor for headache diagnosis, the vast majority in both studies had migraines. However, a comprehensive study also includes people who don’t see their doctor. When they are factored in, the majority of the population experiences tension headaches and don’t seek medical treatment.

A study by Brian C. Callaghan, MD, et. al, titled, “Headaches and Neuroimaging: High Utilization and Cost Despite Guidelines,” reveals that while many patients want imaging to determine whether there is an abnormality with the brain, most headaches are caused by a benign condition.

This study, published in the Journal of the American Medical Association, explains that no more than 3 percent of patients who receive diagnostic imaging have a major abnormality.

Headache Diagnostic Imaging

Why Not Take the Safe Route?

Even a minor possibility that a tumor or brain aneurism exists could seem to warrant the use of diagnostic imaging, if only to rule it out. But the truth is that a patient history and neurological exam can do more, at least early on, to reveal the cause of headaches.

For patients who provide a reasonably normal medical history and for whom a neurological exam reveals no abnormalities, the American Board of Internal Medicine (ABIM) says CT scans and MRIs have a very low likelihood of revealing a dangerous condition in the brain. This is according to an article titled, “Image Testing for Headaches: When You Need Them — and When You Don’t,” published at the ABIM Choosing Wisely website.

Further, there are the risks involved. A CT scan or MRI may reveal what appears to be an abnormality, but isn’t. False positives are always possible, and that brings the patient back for more tests.

Radiation is another concern, and one that shouldn’t be taken lightly by patients. One scan isn’t a known hazard. But the cumulative effect might be, considering the radiation necessary for a head CT scan is as much as 300 times greater than that used for a chest X ray.

A CT scan or MRI might appear to be taking the safe route from the patient’s perspective, but in most cases it’s not. The likelihood of discovering an insidious medical condition is very low, and the risks involved are much higher.

Costs are Another Important Issue Worth Addressing

A doctor visit is largely covered by most medical insurance. And the cost of a medical history and neurological exam is nominal, when compared to that of diagnostic imaging.

ABIM explains that the average cost of a CT scan is approximately $340. But if another, more intensive scan is taken, the cost jumps to nearly $850. MRIs are even more expensive. A standard MRI comes with an average cost of $660. But when one contrast agent is used, the cost increases to nearly $1,000.

This doesn’t cover the costs associated with unnecessary treatments that a false positive can spur, and it also doesn’t cover the additional costs that vary by radiology facility.

The Callaghan et. al. study gives a broader view of the costs involved with headache-related CT scans and MRIs. The authors stated, “Total neuroimaging expenditures were estimated at $3.9 billion over four years [from 2007 to 2010], including $1.5 billion from migraine visits.”

That’s an enormous cost, with minimal return for most patients.

Headache Diagnostic Imaging

Education is a Better Approach

It’s logical that patients who experience headaches want to know the cause, and more important, how to alleviate the pain. But their physician is better qualified to make the first determination, and refer them to a radiology specialist when necessary.

Using a patient history and neurological exam, most doctors can decide whether there’s a deeper problem that diagnostic imaging might reveal.

Some signs that there may be an underlying problem are if a headache comes on both suddenly and explosively, or if a headache is markedly different from others the patient has had. Those are red flags. According to ABIM, this is especially true for patients over the age of 50.

If physical exertion appears to trigger the patient’s headache, or if other symptoms such as vomiting or vision and speech impairment occur, those are more reasons to investigate further.

But for most headaches, even those that are quite painful and persistent, the cost and risks associated with CT scans and MRIs are an unnecessary burden for the patient and the radiologist.

The authors of the “Headaches and Neuroimaging: High Utilization and Cost Despite Guidelines” study explain that although there are guidelines in place to help curtail the excessive use of imaging for headache diagnosis, the numbers are still high.

These guidelines, in effect since 2000, discourage the use of diagnostic imaging as a routine practice. But the results of the study show overuse is still widespread.

They suggest a campaign that encourages patients to have important risk-versus-reward conversations with their doctor. And they believe these conversations may prove more effective than guidelines on their own.

For a patient in pain, there’s nothing more important than finding the cause and getting relief. Although diagnostic imaging seems to be a direct link to what’s creating the pain, in most cases, it’s not.

The costs combined with the risks of CT scans and MRIs for the purposes of diagnosing headache don’t align with the realities. And for the vast majority of patients, these tests will reveal nothing unusual.

A physician’s careful examination of patient history and a neurological exam could reveal a solid reason why these tests might help. But if they do not, diagnostic imaging is a wasteful and unnecessarily expensive approach that’s an extra layer between having a headache and finding relief.

Where the patient’s initial results give reason for diagnostic imaging, SteleRAD’s neuroradiology specialists can help. We offer MRI, CT, image-guided biopsy, and many other imaging modalities and exams to help detect tumors, vascular abnormalities, stroke, and other potential causes of headache.

For more information on how SteleRAD’s radiologists can help with diagnostic imaging: contact us online or give us a call at 954-358-5250.