Tests and Referrals for Headache Management Are on the Rise

But a new study found that it's not necessary.

If you’ve had a headache in the last decade, you’re in good company.

A new study from Beth Israel Deaconess Medical Center (BIDMC) reports that more than 12 million Americans seek medical attention for headaches every year. But, researchers also found that instead of counseling patients about headache causes and potential treatments, physicians are referring patients to specialists and ordering follow-up imaging tests at increasingly high rates—neither of which is particularly valuable in treating routine headaches, researchers say.

In the study, published online in the Journal of General Internal Medicine, researchers analyzed more than 9,000 headache-related doctor visits between 1999 and 2010. John Mafi, the study’s lead author and an internist at BIDMC, says that he and his collaborators discovered that the rates of advanced imaging procedures like CT scans and MRIs for routine headaches have doubled in outpatient settings. At the same time, counseling has decreased by five percent over the same period.

Mafi says that these trends in headache management are a function of “increasingly crunched” office visits between American doctors and patients. Due to increased requirements for documentation and greater patient assertiveness in asking questions about treatments that they’ve researched on their own, the number of items packed into a typical 20-minute office visit has grown considerably, he says.

“The U.S. office visit is under extreme pressure, so visits are increasingly rushed. The first thing to go when visits are rushed is counseling,” Mafi says. “It’s a lot easier to make the patient happy by saying, ‘Okay I’m going to take you seriously, but I don’t have time to talk to you about it. Let’s get you to the specialist, let’s order the scan, and move on.’ It’s much easier to [do that] than it is to take time to counsel the patient and think about what’s triggering [headaches] and going after root causes.”

Mafi says that a greater emphasis on counseling could lead to better treatment for people suffering from headaches, and that the severity and frequency of headaches can often be reduced with lifestyle modifications such as dietary changes, improved sleep hygiene, and stress relief. In addition, he adds, behavioral therapies have been shown to be effective in some cases, as well.

Mafi says that one of the most important things patients can do is to speak openly with their doctors and disregard the preconceived notions about the usefulness of advanced imaging. “There’s an unconscious bias in our healthcare system that patients sometimes feel that more tests mean that their doctors really listened to them. It’s understandable, [but] in the case of headache it doesn’t necessarily mean better care,” he says. “Better care is more related to whether your doctor can accurately diagnose the specific sub-type of headache you have and whether you can think critically about lifestyle and behavioral improvements that can reduce frequency and severity of headaches.”

John Mafi/Journal of General Internal Medicine.

John Mafi/Journal of General Internal Medicine.