This article focuses on the prickly topic of healthcare costs and specifically on reducing spending on neuroimaging for headaches. Epidemiological studies indicate that the prevalence of lifetime headaches is 93 to 99% and accounts for 1.5% of all primary care visits. The cost of neuroimaging for headaches and migraines between 2007 and 2010 in the United States was a whopping $1.2 billion! The Choosing Wisely initiative guidelines by the American College of Radiology and Consumer Reports focuses on reducing healthcare spending and suggests avoiding imaging for uncomplicated headaches. The authors of this article argue that these guidelines are inconsistent with the neurosurgeon’s experience of patients with brain tumours who frequently present with minimal symptoms or isolated headache syndromes. They recommend further research for the development of validated and tested clinical decision rules on the neuroimaging for headaches. This article highlights the problems dividing population-driven healthcare methods and individualised patient tailored medicine.