New Research Says Brain Scans Overused as Diagnostic Tool for Headaches

Emerging research published in JAMA Internal Medicine suggests that despite brain scan risks, neuroimaging is overused as a diagnostic tool for patients who suffer from headaches.  In fact, the study reports that more than $1 billion is spent annually on magnetic resonance imaging (MRI) or computed tomography (CT) scans – even though intracranial pathological conditions are an unlikely cause for migraines and normal headaches.

Scientists from the University of Michigan Health System used data from the national Healthcare Cost and Utilization Project (HCUP) database to review 51 million headache-related visits made by patients age 18 or older.  Researchers discovered that nearly one out of every eight doctor visits resulted in a CT or MRI scan as a diagnostic assessment for headaches or migraines.  Since 2000, medical guidelines have cautioned against brain scans for this purpose as the majority of headaches stem from benign causes.

Four year study finds exponential increase in brain scans

The lead study author Dr. Brian Callaghan, who is an assistant professor of neurology at the University of Michigan Health System, noted that almost $4 billion dollars was spent on brain scans during the course of the four-year study, including some $1.5 billion for migraine patients.  The problem is, researchers pointed out, that the growing demand for MRIs and CT scans as headache exams are patient driven, not a medical requisite.

Another study published in the Journal of the American Medical Association (JAMA) states that the use of diagnostic imaging studies has tripled since 1996, putting thousands of patients at excess risk for harmful radiation exposure. (MRIs do not pose brain scan risks since radiation is not used, only X-rays and CT scans).

One CT scan subjects the body to between 150 and 1,100 times the radiation of an X-ray, which is equivalent to a year’s worth of radiation exposure from natural environmental sources.  The National Cancer Institute estimates that some 29,000 future cancer cases could be traced back to the millions of CT scans performed in U.S. hospitals in 2007.

Are CT scan risks adequately explained to patients ?

Those who request or are ordered to have a computed tomographic scan may not be aware of inherent health risks, according to other research published in JAMA.  Researchers questioned 300 patients who were given CT scans at the Denver Veterans Affairs Medical Center (VAMC) in 2011.

The study found that only 33 percent of patients were told of brain scan risks including elevated radiation exposure, and that most felt their physician had the last say if their CT scan would be given. While the patients discussed the exam and potential hazards with their doctors, researchers determined that the bulk were unaware of the increased cancer risk posed by neuroimaging, and that only 17 percent admitted to being involved in the final decision.

The American College of Radiology recommends that patients do not subject themselves to imaging exams unless there is a demonstrable medical benefit that outweighs any risks. Since cancer risks are low among patients who have undergone repeat CT scans, it is questionable whether one could sue on charges of hospital negligence, even if the risks were not adequately explained beforehand.