Headache Neuroimaging

A Survey of Current Practice, Barriers, and Facilitators to Optimal Use

Evan L. Reynolds PhD; James F. Burke MD, MS; Lacey Evans MPH; Faiz I. Syed MD, MS; Eric Liao MD; Remy Lobo MD; Wade Cooper DO; Larry Charleston IV MD, MSc; Brian C. Callaghan MD, MS


Headache. 2022;62(1):36-56. 

In This Article


In a survey of 431 headache clinicians at the VA health system, we found that a majority of clinicians believed neuroimaging was overused for patients with headaches; however, many would utilize neuroimaging in low-risk scenarios that have a small probability for change in patient management. Utilization of guideline-discordant neuroimaging may have been driven by clinicians' beliefs that the benefits outweigh the harms of headache neuroimaging even in low-risk scenarios, and their preference towards errors of commission rather than omission. Because potential red flags greatly influence decision making, improved evidence on which red flags should influence neuroimaging decisions is desperately needed. This information would allow future guidelines to be more precise in describing the specific clinical scenarios that should prompt neuroimaging. Additionally, CDSS that include details of headache neuroimaging guidelines and patient-specific assessments of neuroimaging benefits/risks may reduce unnecessary neuroimaging, especially for APCs who had high utilization and were the most accepting of such interventions.