Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache

J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1558-64. doi: 10.1136/jnnp.2004.057851.


Objectives: Aims were to investigate (a) whether neuroimaging in patients with chronic daily headache reassures patients or fails to reassure them and/or worsens outcome, impacting on service use, costs, health anxieties, and symptoms, and (b) whether this reassurance process occurs differentially in patients with different levels of psychological morbidity.

Design: randomised controlled trial; setting: headache clinic in secondary care, South London; participants: 150 patients fulfilling criteria for chronic daily headache, stratified using the Hospital Anxiety and Depression Scale (HADS); intervention: treatment as usual or the offer of an MRI brain scan; main outcome measures: use of services, costs, and health anxiety.

Results: Seventy six patients were randomised to the offer of a brain scan and 74 patients to treatment as usual. One hundred and thirty seven (91%) primary care case notes were examined at 1 year, 103 (69%) patients completed questionnaires at 3 months and 96 (64%) at 1 year. Sixty six (44%) patients were HADS positive (scored >11 on either subscale). Patients offered a scan were less worried about a serious cause of the headaches at 3 months (p = 0.004), but this was not maintained at 1 year; other health anxiety measures did not differ by scan status. However, at 1 year HADS positive patients offered a scan cost significantly less, by 465 pounds Sterling (95% confidence interval (CI): -1028 pounds Sterling to -104 pounds Sterling), than such patients not offered a scan, due to lower utilisation of medical resources.

Conclusions: Neuroimaging significantly reduces costs for patients with high levels of psychiatric morbidity, possibly by changing subsequent referral patterns of the general practitioner.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety / etiology*
  • Anxiety / psychology*
  • Attitude to Health
  • Brain / pathology*
  • Chronic Disease
  • Circadian Rhythm*
  • Demography
  • Depression / etiology*
  • Depression / psychology*
  • Female
  • Follow-Up Studies
  • Headache* / diagnosis
  • Headache* / etiology
  • Headache* / psychology
  • Health Care Costs
  • Health Services / economics
  • Health Services / statistics & numerical data
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Pain Measurement
  • Patient Acceptance of Health Care
  • Patient Care Team
  • Primary Health Care
  • Prospective Studies
  • Severity of Illness Index
  • Surveys and Questionnaires