Dr. Schechter's Blog Managing Headache: Too Many Tests Not Enough Counseling

Originally posted: April 16, 2015

Recently MEDSCAPE published an article entitled: Managing Headache: Too Many Tests, Not Enough Counseling? Specifically, the authors noted that:

The application of advanced imaging for headache increased during the study period, from 6.7% of visits in 1999-2000 to 13.9% in 2009-2010.

The percentage of visits featuring counseling decreased from 23.5% in 1999-2000 to 18.5% in 2009-2010.

Their conclusions and implications were:

• The prevalence of recurrent, severe headaches approaches 25%. There are approximately 12 million clinician office visits for headache per year in the United States. The inappropriate application of head CT imaging for headache has been implicated in promoting higher rates of cancer. The most common indication for inappropriate CT imaging is headache. (Note: MRI has no radiation)
  
  
• The current study by Mafi and colleagues suggests that physicians are actually doing worse across time in offering best practices to patients with headache, particularly regarding patient referrals and counseling. Rates of preventive medications for headache did increase across time in the current study
  

This is an important finding. Doctors are doing more testing, exposing more patients to radiation (if CT imaging is used), spending more money, AND doing less counseling.

The authors (Mafi, et al) and I agree that counseling--the doctor educating the patient about his/her condition is vitally important. We also agree that imaging has a role, but is used too often. Testing has replaced a good history and physical examination, and the counseling to unearth the emotional and stress triggers for the headaches that would make the imaging unnecessary in many cases.

It's great to see these authors acknowledge the importance of counseling and the over emphasis on imaging. Let's hope this continues to work its away around the back pain and community and other areas of medicine.