The commonality and cost of headache neuroimaging must be addressed nationally in order to reduce overuse and health care expenditures, according to a research letter published on Mar. 17 by JAMA Internal Medicine.

While the majority of headaches can be attributed to benign factors, both patients and physicians have concerns about intracranial pathologic conditions. Given the small number of significant abnormalities on neuroimaging in patients with chronic headaches, many organizations have begun to create and disseminate guidelines that recommend against routine headache neuroimaging. “However, little is known about recent headache neuroimaging utilization, associated expenditures, and temporal trends in the United States,” wrote lead author Brian C. Callaghan, MD, MS, of the University of Michigan Health System in Ann Arbor, and colleagues.

The letter’s authors employed the National Ambulatory Medical Care Survey to assess outpatient office-based care in the U.S. Specifically, they analyzed all headache visits for patients 18 years or older and utilized descriptive statistics to discern recent headache neuroimaging utilization.

Eighty-eight percent of the patients were younger than 65 and 78 percent were female. The majority of visits were to primary care physicians. Over the duration of four years, 51.1 million headache visits were identified, of which 25.4 million were for migraines. Neuroimaging was performed in 12.4 percent of all headache visits and 9.8 percent of migraine visits. Importantly, the use of this technology was higher if headaches or migraines were listed as the primary diagnosis for the visit.

An estimated $3.9 billion in total neuroimaging expenditures was found over four years. Included in this figure is $1.5 billion in expenditures from migraine visits. Neuroimaging utilization increased from 5.1 percent in 1995 to 14.7 percent in 2010 for all annual headache visits.

In addition to the creation of guidelines and campaigns targeted at the overuse of this technology, required preauthorization of these tests and value-based insurance designs could offer alternative strategies to educating and empowering patients, suggested Callaghan and colleagues.

“Given that headache neuroimaging is common, costly, and likely substantially overused, interventions to curb utilization of these tests have the potential to substantially reduce health care expenditures while improving guideline concordance,” they wrote. “Therefore, optimizing headache neuroimaging practices should be a major national priority.”