Posted on 03/18/2014 9:58:07 AM PDT by SeekAndFind
Guidelines warn doctors against using brain scans for routine headache and migraine cases. Despite this, 12% of patients presenting with headache to a doctor are given scans, according to a study by researchers at the University of Michigan Medical School.
Since the guidelines discouraging the use of magnetic resonance imaging (MRI) and computed tomography (CT) scans for headache were published, scans have become more - rather than less - common for headache sufferers.
Headaches can sometimes be a symptom of a more serious illness, such as a brain tumor, aneurysm or arteriovenous malformation. Doctors might order an MRI or CT scan to put their patients' minds at ease, or even to protect themselves legally if their patient requests a scan.
But previous research has shown that only 1-3% of brain scans of headache patients uncover a malignant growth or problem with the blood vessels in the brain. Also, of these issues found by scans, many do not require immediate treatment.
"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," says Dr. Brian Callaghan, lead author on the study, which is published in JAMA Internal Medicine. "And a lot of the things we find on such scans aren't necessarily something we will do something about."
That the scans have become more widely used for headaches in the face of medical opinion could mean that the rise has been driven by patients putting pressure on their doctors. As such, Dr. Callaghan's team recommends better education for the public on headaches and the recommended applications of brain scans.
The team also suggests that redesigning insurance plans to require patients to pay part of the cost for the scan may discourage unnecessary use of this technology.
$1billion a year cost of scans is 'a conservative estimate'
Using national data on neuroimaging scans and patients reporting headaches to their doctor, the researchers were able to calculate the estimated total costs.
Between 2007 and 2010, doctors received 51.1 million visits from patients with symptoms of headaches, half of which were migraine-related. Of these 51.1 million visits, 12.4% resulted in an MRI or CT scan. The total cost of the scans across these 4 years was $3.9 billion.
"This is a conservative cost estimate based on what Medicare would pay for these tests, says Dr. Callaghan, who adds that:
"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. 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."
"But doctors typically don't consider costs, and patients usually aren't paying directly for these scans," Dr. Callaghan notes. "Insurers may require prior authorizations but still cover the scans if they are ordered."
As well as the estimated $1 billion a year in health care costs - which does not include the cost of follow-up tests - there are other adverse effects for patients having unnecessary scans. CT imaging, for instance, also carries a risk of side effects, due to the radiation exposure from the scan.
Ultimately, Dr. Callaghan's study advises patients that if their doctor does not believe they need a scan, then they should refrain from pushing the issue with them.
Recently, Medical News Today reported on the first device treating migraine headaches to secure the approval of the US Food and Drug Administration.
This is primarily defensive medicine.
For years, we had our mouths xrayed. And years later, they provided a lead shield for the front of you.
My sister had headaches and turned out she had the worst of the worst brain cancer.
Thank God she is still alive - 2 years this July. But she is not the same.
I don’t know. A friend of mine had headaches, they gave her a brain scan - and found a fist-sized tumor. I think brain scans often find things of which a headache is the first sign.
My dental hygienist tells me to close my eyes during the x-ray. I ask how is an eighth inch of skin supposed to block x-rays that shoot through bone and whether they are supposed to keep the x-rays from going into my eyes or shooting out of my eyes and burning the walls.
Then they go behind a lead shielded glass. That always got me.
In a free market that would drive the price of brain scanners down.
But when federal regulations and the threat of lawsuits FORCE insurance companies to cover it at whatever it costs, there is no downward pressure on the costs
That makes sense. One set of x-rays per year vs. a half dozen a day? I would be hiding too.
I don’t have trouble with people choosing to get brain scans if they have a headache, if that’s what they want. I do object to insurance paying for it. If it were voluntary and pricing competitive, people could be sold on paying for a brain scan if they really felt it was helpful.
Tough call. When my daughter was 28 (now 32) she presented with what seemed to be a migraine but ended up being a stroke in progress. Thanks to the doctors and God she is fine now.
Until they solve two problems, this overspending on health evaluations will continue. First, stop the ambulance chasing attorney’s from suing when that one in a hundred headache patients doesn’t get the scan the the brain tumor diagnosis is “delayed”, and finding a way to keep patients from doctor shopping because “I want a scan” until they find a doctor to order one (also second opinions paid for by someone else as is the scan!)
Patients do this quite frequently until they see the doctor who orders what they want or tells them what they want to hear!
In short, then, articles like this that tout ways to save money by avoiding unnecessary tests are nothing but a waste of ink or bandwidth.
No worries. The deathpanels will soon determine who is worthy of a scan.
I went in because of a headache. CT scan found an tumor that required three surgeries to correct.
They showed that I had multiple, bilateral temporal skull fractures, which explained why my head hurt so bad.
Then, I got the medical bills and got another headache.
I’m 51 and in excellent health. Retired Navy vet. Always had a flight physical every year from age 22-44. I still get an annual physical. My birth month is in January, so I had recently my physical with my doc. Background info - In November 2013, I started to get headaches at night and would wake up with a nasty one I’d say 5 out of 7 days/week. Mentioned it to the Doc. He sent me to get a CT scan. By the time I got home, the Radiologist had tried to call me in the car 3 times (ringer was off) and he was talking to my wife when I walked in the door. Turns out I have a grade 3 arteriovenous malformation (AVM). I am now being treated at Johns Hopkins and I get the great privilege of having a full team of neurosurgeons from Johns Hopkins to perform a 12 hour operation next month to remove it. I know there are frivolous tests being performed on people, but I will say that if you have head pain, or headaches, don’t mess around. It could be serious. I’m lucky I got it diagnosed when I did.
Sorry about the bad grammar. I also find that I goof up my speech and have short term memory loss. My hope is that this goes away after the operation.
I work IT in healthcare. One day I was in a Radiologist’s office where they read studies. He had received a scan for someone in the ER complaining of headaches. He jokingly questioned why they were in the ER, and how they were probably a “drug seeker”, until the saw a 10cm ‘round spot’ on their brain. The whole room fell silent for a couple of minutes, and his mood changed completely. The patient was only 23 years old. I thought he was gonna cry, as he was so upset for them.
I suppose the people that came up with this study would have this patient NOT get a scan?
I am reminded of a Dilbert comic where the IT man tells him of a new policy in which draft documents are not permitted to be printed on the color printer. Then two months later, the IT man removes the color printer on the grounds that “it is only rarely used.”
The same thing applies to MRI and CT scanners. They used to be very rare and seldom used, but as they gained in popularity, the technology significantly improved, and they became popular diagnostic tools, commonly available, at far less “per patient” cost.
Only ten or so years ago, some cities even had programs in which otherwise healthy policemen and firemen would be scanned, to create a health baseline for them. Then if they were scanned later, it would be easy to check for changes that might indicate problems.
But even with the baseline checks, they discovered a lot of *potential* problems that could be treated early and prevent severe illness or even death. One female police captain, for example, was discovered to have a slow growing but very dangerous kidney tumor that was still small.
So discontinuing the popular use of this equipment comes across as a “penny wise, pound foolish” idea, by number crunchers who only care about short term savings, not the lives by those affected.
This seems to be their “modus operandi”, of putting out recommendations to stop testing for things like breast cancer, prostate cancer, etc. They seem to have the attitude that if someone over 60 dies because they didn’t get a common test, then “que sera sera”. Not our problem.
Even in this article, they note that between 1-3% of brain scans of headache patients uncover a malignant growth or problem with the blood vessels in the brain.
While they might not care if 3 out of 100 people have a life threatening problem, I would bet that those 3 people and their families would certainly prefer knowing, so they could do things to prevent it.
I pray and will be praying all goes well with you. I am glad you are getting first rate medical care before Obama destroys it completely!
I have migraines and I am one of those they r talking about in the article. I had a scan because my doctor recommended it, I did not bring it up. It came back fine. My migraines are hormonal and controlled with medication but I am so glad I got the scan to rule out anything serious. It is ridiculous the cost of the scans....
Once again, good luck and best wishes on a complete and full recovery. God Bless.
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