Published: Oct 17, 2013
By Sarah Wickline

Full Story:  http://www.medpagetoday.com/MeetingCoverage/ANA/42350

NEW ORLEANS — Despite current guidelines that recommend against CT or MRI for uncomplicated headaches, primary physicians have been ordering nearly $1 billion worth of scans per year, researchers reported here.

During routine visits to a primary care physician, CT or MRI were ordered for 9.1% (95% CI 4.9%-13.2%) of chronic primary headache patients, and for 13.6% (95% CI 5.6%-22.8%) of migraine patients, according to Brian C. Callaghan, MD, of the University of Michigan in Ann Arbor, and colleagues.

Guidelines from the American Academy of Neurology (AAN) and the European Federation of Neurological Societies (EFNS) on migraines have influenced the Choosing Wisely campaign, which has recommended against neuroimaging (CT or MRI) for uncomplicated headaches, the researchers noted.

Based on data on outpatient and office-based care from the National Ambulatory Medical Care Surveys (NAMCS), the researchers investigated the usage of neuroimaging in the US for adult headache complaints from 2007 to 2010.

Excluded from the analysis were patients with the following non-headache “red-flags”: pregnancy, fever, AIDS/HIV, giant cell arteritis trigeminal neuralgia, epilepsy, cancer, and cluster headache.

Among 50.3 million outpatient visits for any type of headache, 12.4% were given a neuroimaging scan. For patients complaining of migraine, 9.8% were given a scan. A primary care physician, not a specialist, ordered these neuroimaging scans.

Even after researchers removed patients with risk factors for intracranial pathology, the researchers still found that 12.0% of headache patients and 8.6% of migraine patients were given scans.

During routine visits to a primary care physician for a chronic primary headache, 9.1% were given a scan (95% CI 4.9%-13.2%). Of patients with a flare up of an old headache problem, 13.6% were given a scan (95% CI 5.6%-22.8%).

Primary care physicians ordered scans for 5.6% of chronic primary migraine during routine visits (95% CI 2.8%-8.3%), and 8.6% of patients with a flare up of an old migraine problem (95% CI 3.0%-14.1%).

According to Callaghan and colleagues, neuroimaging scans only yielded significant abnormalities in 1%-3% of all patients with any type of chronic headaches.

Based on Medicare payment costs for these types of neuroimaging scans, these scans were estimated to have cost $975 million per year, which totaled $3.9 billion from 2007 to 2010.

Patients that were new to a medical practice were three times more likely to be given a scan compared with repeat patients (OR 3.2, 95% 1.4-7.5).

Callaghan and colleagues noted that physicians have reported patient reassurance as the top reason for ordering neuroimaging scans.