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Sharp rise in unnecessary, risky brain scans

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The rate of headache-related doctor visits that end in a brain scan has almost tripled over the past 15 years.

This is the finding from a new study by the University of Michigan, published in JAMA Internal Medicine.

MinnPost reports University of Michigan neurologists looked at national data on brain scans and headache-related physician visits for the years 2007 through 2010.

About half of those visits were for migraines, a severe and often debilitating form of chronic headache that is caused by a combination of genetic and environmental factors.

The data showed Americans made 51 million visits to their doctors for symptoms of headache during that four-year period. Most of the visits were by women and by people under the age of 65. More than half of the visits were to primary care physicians, and about one-fifth were to neurologists.

During those four years, more than 12 percent of the headache visits — and almost 10 percent of the migraine-related ones — led to either an MRI or a CT brain scan.

Modern Healthcare reports spending on the tests was estimated at $3.9 billion. That's $1 billion worth of brain scans each year, according to the study.

“We were very surprised by the magnitude at which these tests were ordered,” says study author, Dr. Brian C. Callaghan, assistant professor of neurology at the University of Michigan. The trend since the mid-1990s has been that physicians increasingly kept ordering the tests, Callaghan says, despite evidence-based guidelines. “This is a big problem and something we need to take very seriously,” he says.

The study found brain scans were "substantially overused" on patients who visit the doctor complaining of headaches and migraines, despite multiple guidelines recommending against their use.

In 2000, for example, the American Academy of Neurology released guidelines that advised against the use of routine brain scans on outpatients with headaches. And the American College of Radiology put imaging for uncomplicated headache on its “Choosing Wisely” list of top five medical tests that physicians and patients should question, MinnPost reports.

Dr. Mitchell H. Katz, deputy editor of JAMA Internal Medicine, noted the costs “that we should care most about as physicians are the unnecessary radiation (in the case of computed tomographic scans) and incidental findings that lead to unnecessary medical procedures and great anxiety on the part of our patients.”

The scans can expose patients to unnecessary radiation or produce false positives.

But as Healthday reports, there are also benefits to getting brain scans. These include finding a brain tumor, stroke or bleeding in the brain.

"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," says 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.

"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."

Here are Harvard Medical School's tips for understanding headaches:

Headaches come in three varieties: Tension, sinus, and migraine. More than 95% of headaches aren’t caused by an underlying disease or structural abnormality. Instead, they spring from common conditions such as stress, fatigue, lack of sleep, hunger, changes in estrogen level, weather changes, or caffeine withdrawal. Most people don’t need a doctor visit or a brain scan. Instead, they need over-the-counter pain relievers (such as aspirin, acetaminophen, ibuprofen, and naproxen) or prescription medications, rest, and relaxation.

If you find yourself taking painkillers for headaches more than a couple of times a week, see your doctor. Red flags that signal the need for medical evaluation include:

  • Not having had headaches before
  • Headaches that worsen over the course of a few weeks
  • A headache that comes on fast (seconds)
  • Headache associated with fever
  • Severe headache in an older person
  • Headache associated with symptoms or signs like swelling in the back of the eyes

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