Through the campaign Choosing Wisely, nine U.S. medical groups are urging doctors to reduce the use of 45 tests, procedures and treatments that may be unnecessary for patients. Each of these groups, which represent different medical specialties, created a list entitled “Five Things Physicians and Patients Should Question.” The one item that pertains to headache appears first on the American College of Radiology‘s list:
Don’t do imaging for uncomplicated headache.
Imaging headache patients absent specific risk factors for structural disease is not likely to change management or improve outcome. Those patients with a significant likelihood of structural disease requiring immediate attention are detected by clinical screens that have been validated in many settings. Many studies and clinical practice guidelines concur. Also, incidental findings lead to additional medical procedures and expense that do not improve patient well-being.
This recommendation makes logical sense and my rational mind agrees with it. However, I don’t know how well it will go over with patients.
There’s no scan or blood work that will prove you have migraine, which can be terribly unsettling. When someone has severe pain in their head, the immediate fear is that they have a brain tumor or aneurysm — you know, something scary and life-threatening. Getting a diagnosis of migraine without having any tests leaves people wondering if something was missed and if their life could be in danger. Negative MRIs and CT scans give patients peace of mind that migraine is the correct diagnosis. (I have no empirical evidence for this analysis, just eight years of interacting with terrified people who have headaches.)
Choosing Wisely’s guidelines do not tell doctors to refrain from testing in all cases, but provide “specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation.” The key here is that physicians and patients discuss the options.
I wonder if any conversation would have calmed my fears sufficiently for me to forgo my first MRI (or CT scan or MRA or spinal tap). I would like to think so, but before I became steeped in the migraine and headache world, practically all my encounters with headache were in movies, TV shows or books, where head pain almost always means brain tumor. Though the gigantic majority of all headache disorders are not life-threatening, society’s general take on headaches falls into two categories: no big deal and big, huge scary deal. For someone to see a doctor about headaches, they usually believe they fall into the latter category.
Tell me about your experience. Have you had imaging done for your headaches or migraines? Could you have accepted your diagnosis without the imaging?
Having focused so long on my headaches without finding a successful treatment, I decided to visit a general neurologist and start from scratch. I brainstormed everything in my body that could possibly be a symptom, even ones I’ve had so long that they seem normal. I also took a list of all the medications and treatments I’ve tried for migraine and chronic daily headache.