Yes, It’s A Headache. No, I Didn’t Need That Brain Scan

Headaches are almost never caused by a tumor, say neurologists. (Getty Images)

Headaches are almost never caused by a tumor, say neurologists. (Getty Images)

Over at NPR, the Shots blog reports that Americans get $1 billion (yes, with a “B”) worth of brain scans every year — because they have a headache. That’s according to research at the University of Michigan.

Headaches are one of the most common reasons people go to the doctor  — up to a quarter of all doctor visits, says Shots.

Sending a billion dollars “down the drain.” Annually.
Presumably people are getting the scans because they’re worried that headache is a sign of something much more scary — say a brain tumor.

There’s just one problem. Most headaches are just that — a headache.

From the Shots post:

(S)ince headaches are almost never caused by a tumor or other serious brain problem, that $1 billion is money down the drain, according to Dr. Brian Callaghan, the assistant professor of neurology who led the study.

“It’s such a big number,” Callaghan told Shots. “It’s just an incredible number of MRIs and CTs that people get.”

From 2007 to 2010, people visited the doctor 51 million times for headache-related problems, according to a national database of outpatient visits. And 12 percent of the time, the doctors sent their patients for a brain scan. Those numbers are on the rise, the analysis found, even though guidelines urge doctors to shun the scans. The results were published Monday in JAMA Internal Medicine.

I’m guilty of sending part of that billion down the drain. A few years ago, I was driving on the highway with my two children in the back seat. I glanced down, then back at the road, and suddenly was seeing double. I managed to pull over but was very shaken. I didn’t know if I was having a stroke. But over a few minutes, the symptoms subsided. I won’t drag you through everything I did next, but in short, I got home safely and made an appointment with the doctor.

She listened to my story, then pointed out that this episode was likely a version of the migraines I get. Migraines are often preceded by an aura, a visual effect that can include flashing lights or blind spots, according to the Mayo Clinic.

But I was freaked out. She referred me to an ophthalmologist with whom I had a long conversation about getting an MRI. He said he wouldn’t do it.

I did it.

I was lucky — not because the MRI came back normal (which I’m sure you expected by now) but also because it didn’t turn up any false positives as can happen, often, with MRIs. If the MRI turns up something suspicious, it can “prompt a cascade of tests and invasive procedures,” Shots says, over things that will never cause any harm.

But that’s not as bad as a CT scan — in that case, you’re exposing your brain to needless radiation. Personally, I like my brain not irradiated, if at all possible.

Patients like me certainly bear some responsibility, but doctors are guilty as well, says Callaghan. Ordering a scan both gets the patient out the door quickly and it does make the patient feel like someone is taking care of them.

Still, there are times you should worry. Again, from Shots:

When should we worry? If a severe headache strikes suddenly, the neurologists say. People also should seek medical help for headaches that are markedly different than ones in the past, are brought on by exertion, or come with fever, vomiting, loss of coordination, or a change in vision, speech or alertness.

In retrospect, my doctor was taking care of me by pointing out the correct problem: the migraine. In the weeks after that first episode, I had a few more episodes of double vision. It turns out if I stopped what I was doing, closed my eyes and took some deep breaths, my vision returned to normal.

That’s a lot cheaper and easier than an MRI.

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