Magnetic resonance imaging in patients with migraine: the results of unsubstantiated referral

Abstract

Introduction.Magnetic resonance imaging (MRI) in patients with migraines often reveals structural brain changes of an unclear aetiology. The effect of these changes on the patients management plan requires further investigation. Theaimof the study was to analyse the management of patients with migraine, in whom structural brain changes were detected on MRI and the validity of MRI referral for migraine. Materials and methods.We examined 50 patients (8 men and 42 women, average age 41.9 11.9 years) with migraine (mainly chronic) and changes on brain MRI. We compared clinical and MRI data, analysed typical medical practice, and conducted a prospective follow-up of the patients for 6 months, during which preventive therapy was administered. Results.Most patients (78%) had predominantly white matter damage of the cerebral hypoperfusion type. None of the patients had indications for MRI. Misinterpretation of the changes on MRI led to most patients (86%) being mistakenly diagnosed with another disease (mainly chronic brain ischaemia) and prescribed inappropriate treatment. Six months of patient follow-up showed the effectiveness of preventive migraine therapy, with a reduction in headache frequency from 19.4 2.9 to 12.6 4.4 days per month (p 0.05). Conclusion. We found unreasonable referrals for brain MRI because of migraine, widespread misinterpretation of MRI changes, and an erroneous diagnosis of cerebrovascular changes as the cause of the migraines.

Keywords

• migraine
• headache
• magnetic resonance imaging
• leukoencephalopathy