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Comment & Response
February 2015

Headaches and Neuroimaging

Author Affiliations
  • 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
JAMA Intern Med. 2015;175(2):312-313. doi:10.1001/jamainternmed.2014.7011

To the Editor I read with interest the research letter by Callaghan et al1 highlighting high utilization of computed tomography (CT) and magnetic resonance imaging (MRI) of the brain in patients with headache, with an estimated annual imaging cost of almost a billion dollars. There are 2 points that I would like to make.

It should be stated that simply decreasing the utilization of neuroimaging in patients with chronic headache might not translate into overall health care cost savings. In patients who scored higher on the Hospital Anxiety and Depression Scale (a self-assessment scale of depression and anxiety), early neuroimaging—by decreasing the use of other medical resources—in fact proved to be a cost-saving strategy.2 While I agree that optimizing headache neuroimaging practices should be a high priority, this should be done without losing sight of overall health care costs for managing these patients.

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