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

Cover Page

Cite item

Full Text


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.

The aim of 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 methodsWe 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.

About the authors

Kirill A. Pozhidaev

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Russian Federation, Moscow

Vladimir A. Parfenov

Sechenov First Moscow State Medical University (Sechenov University)

Russian Federation, Moscow


  1. Stovner L.J., Hagen K., Jensen R. et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27: 193–210. doi: 10.1111/j.1468-2982.2007.01288.x. PMID: 17381554.
  2. Vos T., Flaxman A.D., Naghavi M. et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet 2012; 380: 2163–2196. doi: 10.1016/S0140-6736(12)61729-2. PMID: 23245607.
  3. Ayzenberg I., Katsarava Z., Sborowski A. et al. The prevalence of primary headache disorders in Russia: a countrywide survey. Cephalalgia 2012; 32: 373–381. doi: 10.1177/0333102412438977. PMID: 22395797.
  4. Agostoni E.C., Longoni М. Migraine and cerebrovascular disease: stilla dangerous connection? NeurolSci 2018; 39: 33–37. doi: 10.1007/s10072-018-3429-8. PMID: 29904830.
  5. Burch R.C., Loder S., Loder E. et al. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache 2015; 55: 21–34. doi: 10.1111/head.12482. PMID: 25600719.
  6. Kruit M.C., van Buchem M.A., Hofman P.A.M. et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004; 291: 427–434. doi: 10.1001/jama.291.4.427. PMID: 14747499.
  7. Rocca M.A., Ceccarelli A., Falini A. et al. Brain gray matter changes in migraine patients with T2-visible lesions: a 3-T MRI study. Stroke 2006; 37: 1765–1770. doi: 10.1161/01.STR.0000226589.00599.4d. PMID: 16728687.
  8. Jin C., Yuan K., Zhao L. et al. Structural and functional abnormalities in migraine patients without aura. NMR Biomed 2013; 26: 58–64. doi: 10.1002/nbm.2819. PMID: 22674568.
  9. Yu Y., Zhao H., Dai L. et al. Headache frequency associates with brain micro-structure changes in patients with migraine without aura. Brain Imaging Behav 2020. doi: 10.1007/s11682-019-00232-2. PMID: 31898090.
  10. Cooney B.S., Grossman R.I., Farber R.E. et al. Frequency of magnetic resonance imaging abnormalities in patients with migraine. Headache 1996; 36: 616–621. doi: 10.1046/j.1526-4610.1996.3610616.x. PMID: 8990603.
  11. Aradi M., Schwarcz A., Perlaki G. et al. Quantitative MRI studies of chronic brain white matter hyperintensities in migraine patients. Headache 2013; 53: 752–763. doi: 10.1111/head.12013. PMID: 23278630.
  12. Debette S., Markus H.S. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2010; 341: c3666. doi: 10.1136/bmj.c3666. PMID: 20660506.
  13. Bashir A., Lipton R.B., Ashina S., Ashina M. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology 2013; 81: 1260–1268. doi: 10.1212/WNL.0b013e3182a6cb32. PMID: 23986301.
  14. Kruit M.C., Launer L.J., Ferrari M.D., van Buchem M.A. Infarcts in the posterior circulation territory in migraine. The population-based MRI CAM-ERA study. Brain 2005; 128: 2068–2077. doi: 10.1093/brain/awh542. PMID: 16006538.
  15. Scher A.I., Gudmundsson L.S., Sigurdsson S. et al. Migraine headache in middle age and late-life brain infarcts. JAMA 2009; 301: 2563–2570. doi: 10.1001/jama.2009.932. PMID: 19549973.
  16. Piradov M.A., Tanashyan M.M., Krotenkova M.V. et al. [Advanced neuro-imaging technologies]. Annals of Clinical and Experimental Neurology 2015; 9(4): 11–18. (In Russ.)
  17. Osipova V.V., Azimova Yu.E., Tabeeva G.R. et al. [Diagnosis of head-aches in Russia and post-Soviet countries: the state of the problem and ways to solve it]. Annals of Clinical and Experimental Neurology 2012; 6(2): 16–21. (In Russ.)
  18. Tarasova S.V., Amelin A.V., Skoromets A.A. [The prevalence and detection of primary and symptomatic forms of chronic daily headache]. Kazanskiy meditsinskiy zhurnal 2008; 89(4): 427–431. (In Russ.)
  19. Osipova V.V., Koreshkina M.I. [The role of additional methods of research in the diagnostics of primary and secondary forms of headache]. Nevrologicheskiy zhurnal 2013; 18(1): 4–9. (In Russ.)
  20. Gnedovskaya E.V., Dobrynina L.A., Krotenkova M.V., Sergeeva A.N. [MRI in assessing the progression of cerebral microangiopathy]. Annals of Clinical and Experimental Neurology 2018; 12(1): 61–68. (In Russ.)
  21. Viana M., Khaliq F., Zecca C. et al. Poor patient awareness and frequent mis-diagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol2020; 27: 536–541. doi: 10.1111/ene.14098. PMID: 31574197.
  22. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2013; 33: 629–808. doi: 10.1177/0333102413485658. PMID: 23771276.
  23. Evans R.W., Burch R.C., Frishberg B.M. et al. Neuroimaging for migraine: the American Headache Society systematic review and evidence-based guide-line. Headache 2020; 60: 318–336. doi: 10.1111/head.13720. PMID: 31891197.
  24. DeSouza D.D., Woldeamanuel Y.W., Sanjanwala B.M. et al. Altered structural brain network topology in chronic migraine. Brain Struct Funct 2020; 225: 161–172. doi: 10.1007/s00429-019-01994-7. PMID: 31792696.
  25. Osipova V.V., Azimova Yu.E., Tabeeva G.R. [International principles for di-agnosing headaches: problems of diagnosing headaches in Russia]. Vestnik semeynoy meditsiny 2010; (2): 8. (In Russ.)
  26. Azimova Yu.E., Sergeev A.V., Osipova V.V., Tabeeva G.R. [Diagnosis and treatment of headaches in Russia: the results of a questionnaire survey of doc-tors]. Rossiyskiy zhurnal boli 2010; (3,4): 12–17. (In Russ.)
  27. Lebedeva E.R., Kobzeva N.R., Gilev D.V., Olesen E. [Analysis of the quality of diagnosis and treatment of primary headache in different social groups of the Ural region]. Nevrologiya, neyropsikhiatriya, psikhosomatika 2015; 7(1): 19–26. (In Russ.)
  28. Hom J., Ahuja N., Smith C.D., Wintermark M. R-SCAN: Imaging for head-ache. J Am Coll Radiol 2016; 13: 1534–1535.e1. doi: 10.1016/j.jacr.2016.08.020. PMID: 28341311.
  29. Daymont C., McDonald P.J., Wittmeier K. et al. Variability of physicians’ thresholds for neuroimaging in children with recurrent headache. BMC Pediatr2014; 14: 162. doi: 10.1186/1471-2431-14-162. PMID: 24957861.
  30. Parfenov V.A. [Vascular cognitive impairment and chronic cerebral ischemia (discirculatory encephalopathy)]. Nevrologiya, neyropsikhiatriya, psikhosomatika2019; 10(3): 61–67. (In Russ.)
  31. Golovacheva V.A., Pozhidaev K.A., Golovacheva A.A. [Cognitive impair-ment in patients with migraine: causes, principles of effective prevention and treatment]. Nevrologiya, neyropsikhiatriya, psikhosomatika 2018; 10(3): 141–149. (In Russ.)
  32. Medical Advisory Secretariat. Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis. Ont Health Technol Assess Ser 2010; 10: 1–57. PMID: 23074404.

Supplementary files

Supplementary Files

Copyright (c) 2020 Pozhidaev K.A., Parfenov V.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-83204 от 12.05.2022.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies