Abstract
Background
The objective of this study was to determine whether a brain magnetic resonance imaging
(MRI) scan in patients with a diagnosis of migraine, who insist on the performance
of imaging, is of more benefit in detecting clinically significant unsuspected structural
abnormalities than would be expected by chance.
Methods
This prospective, observational, single-center study was performed from January 1,
2010 to December 31, 2012 and included 100 subjects with a diagnosis of migraine and
normal results on neurologic examination. A brain MRI scan was performed on all patients,
solely at their request, to detect an unsuspected clinically significant structural
lesion.
Results
Of the 100 patients, 86 were female, and the average age was 31.5 years. Forty-five
patients experienced migraine without aura, 41 chronic migraine, and 14 migraine with
aura. All of the patients had normal results on neurologic examination. The duration
of headaches ranged from 4 months to 40 years. In all, 82 of the MRI scans showed
normal results, and 17 revealed clinically insignificant abnormalities. One MRI in
a patient with chronic migraine without aura revealed a meningioma that subsequently
required surgery and radiation therapy. The 1% prevalence of tumor in this study was
then compared with 2 large cohorts of MRI abnormalities in the general asymptomatic
population, in which tumor was found in 35 out of 3000. Fisher's exact test was used
to compare the prevalence of tumor in the study population with the combined cohorts,
and there was no statistical difference between these rates (P > .99).
Conclusions
Brain MRI obtained at the specific request of patients with a diagnosis of migraine
in the presence of normal neurologic examination results has a yield that is equivalent
to that of the general asymptomatic population. Patients do not seem to have more
insight than the examining clinician with regard to detecting underlying structural
abnormalities, and brain MRI should not performed as part of the routine evaluation
of migraine without a clear clinical indication.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The prevalence, impact, and treatment of migraine and severe headache in the United States: a review of statistics from national surveillance studies.Headache. 2013; 53: 427-436
- Neuroimaging in the evaluation of patients with non-acute headache.Cephalalgia. 2005; 25: 30-35
- Migraine and structural changes in the brain: a systematic review and meta-analysis.Neurology. 2013; 81: 1260-1268
- Migraine is associated with magnetic resonance imaging white matter abnormalities: a meta-analysis.Arch Neurol. 2004; 61: 1366-1368
- Structural brain changes in migraine structural brain changes in migraine.JAMA. 2012; 308: 1889-1897
- MR imaging of the brain in patients with migraine headaches.AJNR Am J Neuroradiol. 1991; 12: 521-524
- The International Classification of Headache Disorders, 2nd edition.Cephalagia. 2004; 24: 8-160
- Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers.JAMA. 1999; 282: 36-39
- Incidental findings on brain MRI in the general population.N Engl J Med. 2007; 357: 1821-1828
- Developmental venous anomalies.Handb Clin Neurol. 2017; 143: 279-282
- Asymptomatic Chiari Type 1 malformation identified on magnetic resonance imaging.J Neurosurg. 2000; 92: 920-926
- Is the incidence of meningiomas underestimated? A regional survey.Br J Cancer. 2008; 99: 182-184
- Headaches and neuroimaging.JAMA Intern Med. 2014; 174: 819-821
Article info
Publication history
Published online: November 13, 2017
Footnotes
Funding: The statistical work was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.
Conflict of Interest: None.
Authorship: Both authors had access to the data and were involved in writing the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
