Migraine Evaluation in Setting of Normal Neurologic Function May Not Necessitate MRI

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Brain MRI for the evaluation of headache should only be performed when there is a clear clinical suspicion of structural disease and not only at the insistence of a patient.
Brain MRI for the evaluation of headache should only be performed when there is a clear clinical suspicion of structural disease and not only at the insistence of a patient.

Routine brain magnetic resonance imaging (MRI) is not necessary for those with migraine who have normal neurologic function unless there is a clear clinical indication that there are underlying structural abnormalities, according to an observational study published in the American Journal of Medicine.

Investigators evaluated clinical data from 100 patients with diagnosed migraine and normal neurologic examination. Participant-requested brain MRI data were available for analysis of any potential unsuspected clinically significant structural lesion.

Included study participants had migraine without aura (n=45), chronic migraine (n=41), and migraine with aura (n=14). Headache durations ranged from as little as 4 months to as long as 40 years. MRI scans were normal in 82 participants, whereas clinically insignificant abnormalities were found in 17 participants.

Only 1 patient with chronic migraine without aura was found to have a significant lesion on MRI (a grade 2 meningioma), which prompted surgical excision and postoperative radiation therapy. On study enrollment, this patient had a 20-year history of headaches.

Investigators compared tumor prevalence in this study with that of 2 larger cohorts of MRI abnormalities found in the general asymptomatic patient population. In the general asymptomatic population, a total of 35 tumors were found in 3000 people, which is comparable to the finding in this analysis (P >.99).

Considering that only a small proportion of those with normal neurologic examination results may have a significant abnormality, performing MRI may not be practical or feasible for most patients and “should only be performed when there is reasonable clinical suspicion of underlying structural disease and not solely at the insistence of the patient.”

Reference

Mullally WJ, Hall KE. Value of patient-directed brain magnetic resonance imaging scan with a diagnosis of migraine [published online November 13, 2017]. Am J Med. doi:10.1016/j.amjmed.2017.10.042

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