Rationale for issuing neuroimaging requests for patients with primary headaches in China

Area of Science:

• Neurology
• Radiology
• Health Services Research

Background:

• Primary headaches are common neurological conditions.
• The use of neuroimaging for primary headaches varies globally.
• Understanding diagnostic practices in China is crucial.

Purpose of the Study:

• To determine the prevalence of neuroimaging in Chinese patients with primary headaches.
• To explore the reasons behind clinician-initiated neuroimaging requests for primary headaches.

Main Methods:

• Cross-sectional study involving 2263 patients with primary headaches across six hospitals in China.
• Convenience sampling for patient recruitment.
• Clinician interviews (in-depth and group) to understand rationale for neuroimaging requests.

Main Results:

• Nearly 90% of patients with primary headaches underwent neuroimaging (MRI, CT, or both).
• Most interviewed clinicians (15/16) did not issue neuroimaging requests for primary headaches.
• Reasons for requests included avoiding misdiagnosis, reducing uncertainty, managing disputes, meeting patient needs, and fulfilling hospital metrics.

Conclusions:

• Neuroimaging use for primary headaches in China is higher than in other countries.
• Strategies are needed to optimize neuroimaging use and reduce low-value care for primary headaches.