Headache neuroimaging: Routine testing when guidelines recommend against them.

Area of Science:

• Neurology
• Health Services Research
• Medical Imaging

Background:

• Neuroimaging is often utilized in outpatient headache evaluations.
• Guidelines exist for appropriate neuroimaging use in headache patients.
• Understanding patient-level factors influencing neuroimaging is crucial for optimizing care.

Purpose of the Study:

• To identify patient-level factors associated with neuroimaging use in outpatient headache settings.
• To analyze the frequency of neuroimaging in specific headache populations.

Main Methods:

• Utilized data from the National Ambulatory Medical Care Surveys (2007-2010).
• Employed multivariable logistic regression to assess patient-level factors.
• Applied a Markov model with Monte Carlo simulation for longitudinal utilization estimation.

Main Results:

• Migraine and chronic headache diagnoses were linked to lower neuroimaging use, but it remained frequent.
• Absence of red flags for intracranial pathology did not decrease neuroimaging orders.
• Neurologist visits and initial practice visits were associated with increased neuroimaging utilization.

Conclusions:

• Neuroimaging is routinely prescribed for outpatient headache patients, including those with conditions like migraines and chronic headaches where guidelines advise against it.
• The study highlights a discrepancy between clinical guidelines and actual practice regarding neuroimaging in headache management.