Neuroimaging Recommended for Certain Migraines, Not All

February 6, 2020

American Headache Society published recommendations for when neuroimaging is most beneficial

Not all patients who experience a migraine should undergo neuroimaging, according to recommendations released by the American Headache Society (AHS).

If a patient presents with a headache consistent with migraine, but he or she also has a normal neurological exam without any other points of concern, additional neuroimaging isn’t necessary. Only patients who experience other factors that point to potentially negative underlying problems should receive CT or MRI scanning.

These recommendations were published recently in a study in Headache. They were based on a review of 23 studies that included adults who pursued outpatient treatment for migraine and who received either MRI or CT scans.

Patients in the studies who had headaches consistent with migraine demonstrated no differences to patients in the general population, according to the multi-institution team that reviewed the existing literature. Existing literature supports that finding, the team said. Consequently, the AHS recommends neuroimaging in these patients isn’t necessary.

However, there are some circumstances in which patients with headaches consistent with migraine should receive further neuroimaging. Additional imaging should be considered in these situations:

  • Unusual, prolonged, or persistent aura

  • Increasing frequency, severity, or change in clinical features

  • First or worst migraine

  • Migraine with confusion

  • Migraine with motor manifestations (hemiplegic migraine)

  • Migraine with brainstem aura

  • Aura without headache, side-locked headache, late-life migraine accompaniments

  • Post-traumatic headache

Overall, the team said, following these recommendations could reduce the overutilitation of neuroimaging. But, they noted these recommendations do not mandate any particular course of medical care, and they are not intended to replace professional judgement.