Advanced Imaging for Uncomplicated Headache Doubled in Recent Years

This is for our providers who treat pain patients.

Guideline-discordant management of headache — for example, use of advanced imaging and referral to other physicians — roughly doubled from 1999 to 2010, according to a study in the Journal of General Internal Medicine.

Using data from two national surveys, researchers studied nearly 9400 outpatient visits for headache in that period, representing some 144 million visits across the U.S. Visits with symptoms that suggested diagnoses other than uncomplicated headache were excluded.

Lifestyle counseling for headache prevention — a first-line approach in evidenced-based guidelines — dropped from 24% of visits in 1999-2000 to 19% in 2009-2010. At the same time, use of computed tomography or magnetic resonance imaging increased (from 7% to 14%), as did referrals to other physicians (7% to 13%). Results were similar in those with migraine versus non-migraine headache, and those with acute versus chronic symptoms.

The authors conclude: “Contrary to numerous guidelines, clinicians are increasingly ordering advanced imaging and referring to other physicians, and less frequently offering lifestyle counseling to their patients.”