neuroimaging in migraine
Last reviewed 07/2021
- neuroimaging should be considered in patients with nonacute headache
and an unexplained abnormal finding on the neurologic examination
- recommendation is based on the finding that an abnormal neurologic
examination increases the likelihood of intracranial pathology, such as
brain tumor, arteriovenous malformation and hydrocephalus. The absence
of abnormalities on neurologic examination reduces the odds of an abnormality
on CT or MRI
- recommendation is based on the finding that an abnormal neurologic
examination increases the likelihood of intracranial pathology, such as
brain tumor, arteriovenous malformation and hydrocephalus. The absence
of abnormalities on neurologic examination reduces the odds of an abnormality
on CT or MRI
- no recommendations are made regarding neuroimaging in the presence or
absence of neurologic symptoms
- while the data suggest that headache worsened by the Valsalva maneuver,
headache that awakens the patient, new-onset headache in older patients
or progressively worsening headache increases the likelihood of significant
intracranial pathology, the absence of such signs and symptoms is less
reliable than their presence
- while the data suggest that headache worsened by the Valsalva maneuver,
headache that awakens the patient, new-onset headache in older patients
or progressively worsening headache increases the likelihood of significant
intracranial pathology, the absence of such signs and symptoms is less
reliable than their presence
- neuroimaging is not usually warranted in patients with migraine and normal
findings on neurologic examination
- a lower threshold for CT or MRI may be applicable in patients with atypical
features or with headaches that do not fulfill the definition of migraine.
These recommendations are based on the finding that an abnormality is
unlikely to be found on CT or MRI in patients with migraine and a normal
neurologic examination
- a lower threshold for CT or MRI may be applicable in patients with atypical
features or with headaches that do not fulfill the definition of migraine.
These recommendations are based on the finding that an abnormality is
unlikely to be found on CT or MRI in patients with migraine and a normal
neurologic examination
- imaging in tension-type headaches
- because of insufficient evidence, a recommendation regarding neuroimaging
in patients with tension-type headaches cannot be made. In two studies,
no lesions were found in patients with tension-type headaches and normal
neurologic examination
- because of insufficient evidence, a recommendation regarding neuroimaging
in patients with tension-type headaches cannot be made. In two studies,
no lesions were found in patients with tension-type headaches and normal
neurologic examination
- use of MRI or CT
- because of insufficient evidence, recommendations regarding the comparative
sensitivity of MRI and CT cannot be made
- the greater resolution of MRI appears to be of little clinical importance in the evaluation of nonacute headache. No comparative data exist for the effectiveness of CT scanning with and without enhancement
- because of insufficient evidence, recommendations regarding the comparative
sensitivity of MRI and CT cannot be made
Notes:
- principles for diagnostic imaging
- (1) testing should be avoided if it will not lead to a change in management;
- (2) testing is not recommended if the patient is not significantly more likely than a person in the general population to have a significant abnormality; and
- (3) testing that is not normally recommended may make sense in individual cases, such as in patients who are excessively worried about a serious problem as the cause of their headaches.
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