Headaches are a billion-dollar industry — that is, $1 billion is spent every year on brain scans for individuals who suffer with a headache.
And these brain scans are not just for those who suffer with chronic migraines, but also for those with "routine" headaches. Since about 2000, multiple sets of guidelines from neurologists and radiologists alike have been in effect recommending against MRIs and CT scans for what are benign headaches.
Nevertheless, a recent study in JAMA Internal Medicine examined a total of 51 million patients with headaches in a four-year span. Researchers found that neuroimaging was performed in 12.4 percent of all headache visits, including 9.8 percent of all migraine visits, and the costs were upwards of $3.9 billion.
Some experts think this number is a conservative estimate, since it is based solely on what Medicare would pay for such a procedure.
In a 15-year span from 1995 to 2010, the use of MRIs and CT scans increased from 5.1 percent to 14.7 percent. It is thought that patient demand is the reason for the increase and for driving up the costs.
Rarely do doctors consider the cost of these procedures, so researchers suggest that better education of the public and insurance plans that ask patients to pay part of the cost may be needed to reverse this trend.
Clearly, headaches can be a symptom of a more serious illness, such as a tumor, an aneurysm or some other kind of malformation or blood vessel issue. But even at that, only 1-3 percent of brain scans of headache patients uncover a malignancy or other serious problem. And many times, issues found by scans often do not require immediate treatment.
New forms of treatment are needed for serious, severe, debilitating headaches (termed "suicide" headaches) and for tension headaches and migraines, and two new procedures are on the horizon.
People who get severe headaches can be literally crippled by the extreme pain. In a pilot study in Norway, Botox is being used to treat these headaches. The surgeon injects a dose of Botox to the area around the nerve bundle. The whole process takes about a half-hour, and the treatments lasts for between three and eight months before another injection is given.
"Botox is a neurotoxin that stops the flow of impulses along the nerves," says researcher Erling Tronvik. "In theory, the connection between the two nerves in the bundle is reduced or eliminated."
On another front, the FDA has just approved an antimigraine device, the first such device to prevent migraine headaches. The device is small, battery-powered and portable. It is worn across the forehead and over the ears, like a headband.
The device applies electric current to the nerve that causes migraines. A study in Belgium found that those who used the device reported significantly fewer days with migraines per month than those who used a placebo.
Each treatment is different, but both target the nerves that are associated with these kinds of headaches, demonstrating that considering nerve involvement appears to be an important breakthrough in treating "killer" headaches.
