News & Commentary

Treating Headaches Becomes a Headache


The use of CTs and MRIs in the workup for headaches more than doubled between 1999–2000 and 2009–2010, according to a study in the Journal of General Internal Medicine. During the same period, clinicians were also not as likely to go the less expensive, guideline-driven route of giving their patients tips on managing headaches, which include tactics for reducing stress and avoiding foods that trigger headaches in some people.

The underlying problem seems to be the overburdening of primary care physicians, according to the Beth Israel Deaconess Medical Center researchers who conducted the study. Primary care physicians just don’t have the time to talk with patients, they said.

Counseling, considered the first-line approach to headache treatment, declined from 23.5% to 18.5% during the 10 years the study covered.

PCPs and specialists are also referring headache sufferers to other physicians more often. Referrals to other physicians increased from 6.9% to 13.2%.

There is some good news about medication use for headaches. Unlike trends in the treatment of back pain, there has been no increase in the use of opioids, barbiturates, and other medications that should be used sparingly.

The Boston researchers make the case that imaging of the head should be reserved for people with neurologic deficits, cancer, trauma, and HIV. That’s a relatively small slice of the population. In contrast, headache is one of the main reasons people go to the doctor. Headaches account for 12 million visits per year in the U.S. and cost upwards of $31 billion, note the researchers.