Headache neuroimaging: Routine testing when guidelines recommend against them. (November 2015)

• Record Type: Journal Article
• Authors: Callaghan, Brian C; Kerber, Kevin A; Pace, Robert J; Skolarus, Lesli; Cooper, Wade; Burke, James F
• Is Part Of: Cephalalgia. Volume 35:Number 13(2015)
• Page Start: 1144
• Page End: 1152
• Publication Date: 2015-11
• Subjects: Headaches -- migraines -- diagnostic testing -- health care efficiencies; Headache -- Periodicals; 616.8491
• DOI: 10.1177/0333102415572918
• Languages: English
• ISSNs: 0333-1024

Abstract

Aims: The aim of this article is to determine the patient-level factors associated with headache neuroimaging in outpatient practice. Methods: Using data from the 2007–2010 National Ambulatory Medical Care Surveys (NAMCS), we estimated headache neuroimaging utilization (cross-sectional). Multivariable logistic regression was used to explore associations between patient-level factors and neuroimaging utilization. A Markov model with Monte Carlo simulation was used to estimate neuroimaging utilization over time at the individual patient level. Results: Migraine diagnoses (OR = 0.6, 95% CI 0.4–0.9) and chronic headaches (routine, chronic OR = 0.3, 95% CI 0.2–0.6; flare-up, chronic OR = 0.5, 95% CI 0.3–0.96) were associated with lower utilization, but even in these populations neuroimaging was ordered frequently. Red flags for intracranial pathology did not increase use of neuroimaging studies (OR = 1.4, 95% CI 0.95–2.2). Neurologist visits (OR = 1.7, 95% CI 0.99–2.9) and first visits to a practice (OR = 3.2, 95% CI 1.4–7.4) were associated with increased imaging. A patient with new migraine headaches has a 39% (95% CI 24–54%) chance of receiving a neuroimaging study after five years and a patient with a flare-up of chronic headaches has a 51% (32–68%) chance. Conclusions: Neuroimaging is routinely ordered in outpatient headache patients including populations where guidelines specifically recommend against their use (migraines, chronic headaches, no red flags).