A study out of Beth Israel Deaconess Medical Center (BIDMC) found that from 1999 to 2010 headache treatment protocols have become more dependent on the use of advanced imaging. Such tests expose patients to what is often unnecessary radiation, while also increasing health care costs.

“I think doctors feel they are doing the right thing by ordering a CT scan or MRI for a patient who suffers from headaches. It makes the patient feel like the doctor is validating their pain,” Dr. John Mafi, a research fellow and practicing internal medicine physician at BIDMC, told DOTmed News. “But overtreatment can lead to harm through unnecessary exposure to radiation and other complications.”

Mafi said that headache is one of the most common reasons patients visit their doctor, although headache rates have remained unchanged. The study analyzed 9,363 patients and excluded patients who were symptomatic for tumors, cancer or trauma. The study also noted that referrals from primary care physicians to specialists, such as neurologists, almost doubled to 13.9 percent of patients, which also increased costs.
Mafi is a proponent of lifestyle changes to help headache patients. He stressed that while no study has specifically been conducted on the relationship between physician counseling and relief of chronic headaches, he said other studies point in that direction.

“There are good studies that demonstrate that patients who take steps to better manage stress, improve sleep, and who make other healthy behavioral changes – via cognitive behavioral therapy – improve,” he said. “The truth is that for many conditions patients often feel better if we recommend lifestyle changes and allow time for the body to heal.”

According to Mafi the U.S. has the highest per capita health care spending rate in the world, but is in the middle of the pack for outcomes. With the mandates under the Affordable Care Act to reduce costs and manage wellness, new treatment protocols that offer better outcomes must be considered.

“The doctor-patient relationship is very sacred. It’s a really sensitive issue to talk to patients about universal costs when they are suffering. But over-testing doesn’t help patients – and they pay a lot of that cost out-of-pocket,” Mafi said. “So I look at it from the viewpoint of what’s best for the patient and talk to them as I do when one of my own family is in the hospital.“

According to Mafi, about one in 10 patients admitted to the hospital develop potentially avoidable complications, a concern that can be carried over to a lesser extent to the outpatient setting.

“Whenever possible, it’s better for the patient and helps control costs to prescribe noninvasive therapies first,” he said. “There is a general feeling among patients if care costs more, it must be better. So we have to be humble about our abilities and have that critical conversation with the patient about their role in feeling better.”

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