A new study by researchers from Beth Israel Deaconess Medical Center (BIDMC) suggests some of the costs of upward of $31 billion annually could be offset by doctors ordering fewer tests and an increased focus on counseling about lifestyle changes.

The findings of the study, published online by the Journal of General Internal Medicine found that, instead of talking to patients about the causes and potential sources of relief from headache pain, clinicians are increasingly ordering advanced imaging and providing specialist referrals, both of which are considered to be of little value in treating routine headaches.

Lead author John N. Mafi, MD, a fellow in the Division of General Medicine and Primary Care at BIDMC notes the assessment of headaches depends on identifying the relatively rare instances where serious underlying causes are suspected.

“I was particularly alarmed about the overall trend of more imaging tests, medications, and referrals alongside less counseling,” says Mafi. “These findings seem to reflect a larger trend in the US healthcare system beyond just headache: over-hurried doctors seem to be spending less time connecting with their patients and more time ordering tests and treatments.”

The data reflect a nationally representative sample of visits for headaches from the National Ambulatory Medical Care Survey and the National Hospital Medical Care Survey. The data excluded visits with “red flags” such as neurological deficit, cancer or trauma.

Senior author Bruce Landon, MD, also of BIDMC says a 2010 report in the Journal of the American College of Radiology “found 62% of CT head/brain scans are inappropriate according to evidence-based guidelines, most frequently ordered inappropriately for chronic headache.”

Landon adds, “this overuse has significant consequences, because incidental findings provoke unnecessary patient anxiety, can lead to more invasive procedures and often require follow-up testing.”


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