Wondering if your physician should have prescribed imaging for your frequent migraine attacks? The answer might surprise you. Contrary to common belief, imaging such as CT scans or MRIs isn’t always necessary. Discover why routine imaging isn’t recommended for migraine diagnosis, how it can lead to unnecessary anxiety and costs, and why focusing on symptom description and keeping a detailed headache diary remain key to effective diagnosis.
Why? Wouldn’t it be better to ensure there’s nothing else going on that could be treated and potentially fix the migraine for good?
It’s quite normal to look for precise answers on why the migraine is occurring. The problem is, if we scan everyone we will find many completely benign things that have nothing to do with the headaches and may just worry you uselessly. Common benign findings include enlarged ventricles, arachnoid cysts, Chiari malformation, benign brain tumours, and sinus polyps. For every 100 MRIs or CT scans done, between 5 and 10% will show some benign abnormality (something that is seen on the image but has no repercussions on your health).
Negative Consequences of Unnecessary Imaging:
- Radiation exposure (CT scans)
- Costs to individuals and the healthcare system
- Delays for those needing urgent imaging
- Anxiety from benign findings and further unnecessary tests
Why Can’t Migraine Be Seen on Scans?
Migraine is a result of microscopic inflammatory and electrical changes in the brain, which are invisible on standard imaging. As we learn more about migraine, this may change in the future but for now giving an accurate description of your symptoms is the most important way to help your doctor make a diagnosis.
Migraine is invisible on the MRI but very visible in a headache diary. Consider starting one!
When to Seek Imaging
New, unusual headaches or red flags should prompt reevaluation and possibly imaging.
Key Points
- Migraines can’t be diagnosed with CT or MRI.
- Migraines involve electrical and inflammatory processes invisible on scans.
- Diagnosis is based on patient history, lack of red flags, and a normal neurological exam.
- Imaging is needed only to rule out other causes based on medical history.
- Changes in headache patterns should be reassessed.
References
- Morris Z, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2009;339:b3016.
- May A. Pearls and pitfalls: Neuroimaging in headache. Cephalalgia. 2013;33(8):554-65.
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