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Headache neuroimaging: Routine testing when guidelines recommend against them
Open accessAbstract
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).
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Both our findings and the US study indicate overuse of MRI and CT in primary headaches.
“Even though our findings and the results of the US study cannot be compared because of different methods, both studies indicate overuse of MRI and CT in primary headaches.”
From Prevalence, management and burden of episodic and chronic headaches—a cross-sectional multicentre study in eight Austrian headache centres (2015) · cites this paper as [25]
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Metadata
- Authors
- Callaghan, B. C., Kerber, K. A., Pace, R. J., Skolarus, L., Cooper, W., & Burke, J. F.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Callaghan, Brian C
- Venue
- Cephalalgia
- Publisher
- SAGE Publications
- Published
- 2015-02-12
- Volume
- 35
- Issue
- 13
- Pages
- 1144-1152
- ISSN
- 0333-1024 (ISSN-L)
- 1468-2982
- PMC
- PMC5522585
- OpenAlex
- W2332474150
- Cited by
- 51
- References
- 22
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 3
- FWCI
- 4.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cephalalgia (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (R18HS017690)
- National Institute on Deafness and Other Communication Disorders (R01DC012760)
- National Institute of Neurological Disorders and Stroke (K08NS082597, R21NS084081, K23NS073685, K23NS079417)
- National Center for Research Resources (K23RR024009)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Migraine and Headache Studies
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Keywords
- migraine, chronic headache, guideline adherence, outpatient care utilization, National Ambulatory Medical Care Survey
- MeSH terms
- Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Headache, Humans, Male, Middle Aged, Monte Carlo Method, Practice Guidelines as Topic, Health Care Surveys, Young Adult, Neuroimaging
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