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Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache
  1. L Howard1,
  2. S Wessely2,
  3. M Leese1,
  4. L Page2,
  5. P McCrone1,
  6. K Husain2,
  7. J Tong2,
  8. A Dowson3
  1. 1Health Services Research Department, Institute of Psychiatry, London, UK
  2. 2Department of Psychological Medicine, Institute of Psychiatry, London, UK
  3. 3Headache Clinic, King’s College Hospital, London, UK
  1. Correspondence to:
 Dr Louise Howard
 Health Services Research Department, PO 29, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK;


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.

Methods: 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 (95% confidence interval (CI): −£1028 to −£104), 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.

  • CDH, chronic daily headache
  • 95% CI, 95% confidence interval
  • GP, general practitioner
  • HADS, Hospital Anxiety and Depression Scale
  • HAQ, Health Anxiety Questionnaire
  • IPQ-R, Revised Illness Perception Questionnaire
  • SF36, Medical Outcome Study Short Form 36
  • VAS, visual analogue scale
  • diagnostic tests
  • headache disorders
  • randomised controlled trial
  • routine

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  • This study was funded by The Wellcome Trust, grant number GR050178A.

  • Competing interests: none declared