Abstract
BackgroundNeuroimaging for headaches is both common and costly. While the costs are well quantified, little is known about the benefit in terms of diagnosing pathology. Our objective was to determine the role of early neuroimaging in the identification of malignant brain tumors in individuals presenting to healthcare providers with headaches.MethodsThis was a retrospective cohort study using administrative claims data (2001–2014) from a US insurer. Individuals were included if they had an outpatient visit for headaches and excluded for prior headache visits, other neurologic conditions, neuroimaging within the previous year, and cancer. The exposure was early neuroimaging, defined as neuroimaging within 30 days of the first headache visit. A propensity score-matched group that did not undergo early neuroimaging was then created. The primary outcome was frequency of malignant brain tumor diagnoses and median time to diagnosis within the first year after the incident headache visit. The secondary outcome was frequency of incidental findings.Results22.2% of 180,623 individuals had early neuroimaging. In the following year, malignant brain tumors were found in 0.28% (0.23–0.34%) of the early neuroimaging group and 0.04% (0.02–0.06%) of the referent group (P<0.001). Median time to diagnosis in the early neuroimaging group was 8 (3–19) days versus 72 (39–189) days for the referent group (P<0.001). Likely incidental findings were discovered in 3.17% (3.00–3.34%) of the early neuroimaging group and 0.66% (0.58–0.74%) of the referent group (P<0.001).ConclusionsMalignant brain tumors in individuals presenting with an incident headache diagnosis are rare and early neuroimaging leads to a small reduction in the time to diagnosis.
Highlights
Headache diagnoses are common, resulting in numerous outpatient visits, emergency department encounters, prescriptions, and diagnostic tests [1,2,3,4,5]
Our objective was to determine the role of early neuroimaging in the identification of malignant brain tumors in individuals presenting to healthcare providers with headaches
Malignant brain tumors in individuals presenting with an incident headache diagnosis are rare and early neuroimaging leads to a small reduction in the time to diagnosis
Summary
The American Board of Internal Medicine Foundation Choosing Wisely campaign has identified neuroimaging for headaches as an area for more judicious use [11, 12]. The most common rationale for performing headache neuroimaging is to attempt to detect a treatable cause [13] Malignant brain tumors, such as gliomas and metastatic brain tumors, carry a poor prognosis, and survival can be modestly improved with aggressive interventions including surgery, chemotherapy, and radiation [14,15,16,17,18]. Other findings, such as arteriovenous malformations, should rarely, if ever, lead to changes in treatment strategy as interventional therapy does not reduce the risk of death or stroke compared to observation [19] Still others, such as intracranial bleeding, usually present in the emergency setting. Our objective was to determine the role of early neuroimaging in the identification of malignant brain tumors in individuals presenting to healthcare providers with headaches
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