We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letter | Health Care Reform

Headaches and Neuroimaging:  High Utilization and Costs Despite Guidelines

Brian C. Callaghan, MD, MS1; Kevin A. Kerber, MD, MS1; Robert J. Pace, MD1; Lesli E. Skolarus, MD, MS1; James F. Burke, MD, MS1,2
[+] Author Affiliations
1Department of Neurology, University of Michigan Health System, Ann Arbor
2Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
JAMA Intern Med. 2014;174(5):819-821. doi:10.1001/jamainternmed.2014.173.
Text Size: A A A
Published online


While most headaches are attributable to benign conditions, patients and physicians are often concerned about intracranial pathologic conditions. However, the yield of significant abnormalities on neuroimaging in patients with chronic headaches is 1% to 3%.13 Given the comparable yield in patients without headaches, multiple guidelines have recommended against routine headache neuroimaging,46 and efforts to improve the efficiency of health care utilization, such as the Choosing Wisely campaign (ABIM [American Board of Internal Medicine] Foundation; http://www.choosingwisely.org), have identified these tests as a target. However, little is known about recent headache neuroimaging utilization, associated expenditures, and temporal trends in the United States.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Trends in Neuroimaging Utilization for the Entire Headache Population From 1995 Through 2000 and 2005 Through 2010

CT indicates computed tomography; and MRI, magnetic resonance imaging. Error bars indicate 95% confidence interval.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Does This Patient With Headaches Have a Migraine or Need Neuroimaging?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient With Headache Have a Migraine or Need Neuroimaging?