re migraines and scans dn from nyeda cnsvax uwec edu david nye dn a neurology dn consultation is cheaper than a scan and also better because a neurologist can make a differential diagnosis between migraine tension type headache cluster benign intracranial hypertension chronic paroxysmal hemicrania and other headache syndromes that all appear normal on a scan a neurologist can also recommend a course of treatment that is appropriate to the diagnosis dn also since many people are convinced they have brain tumors or other dn serious pathology it may be cheaper to just get a ct scan then have dn them come into the er every few weeks dn and easier than taking the time to reassure the patient right dn personally i don t think this can ever be justified sigh it may never be justifiable but i sometimes do it even after i try to show thoroughness with a detailed history neurologic examination and discussion with the patient about my diagnosis salted with lots of reassurance patients still ask why can t you order a scan so we can be absolutely sure aunt millie often gets into the conversation as in they ignored aunt millie s headaches for years and then she died of a brain tumor aneurysm or whatever if you can get away without ever ordering imaging for a patient with an obviously benign headache syndrome i d like to hear what your magic is every once in a while i am able to bypass imaging by getting an eeg mind you i don t think eeg is terribly sensitive for brain tumor but the patient feels like something is being done as if the hours i spent talking with and examining the patient were nothing the eeg has no ionizing radiation it s much cheaper than ct or mri and the eeg brings in some money to my department slmr e mail jim zisfein factory com jim zisfein
