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Chronic Migraine, need help with MRI results
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Chronic Migraine, need help with MRI results

I have had migraines since I was a teenager, I am now a 30+ year old and for the past month hae had almost daily migraines that have not responded to the normal course of treatment.  The headache intensity has been helped but not resolved.

I had an MRI and am now a bit worried and am hoping that I can get some answers please. In addition to the MRI I have undergone a sleep study.  I have an appointment to review the results of both but would like help deciphering the information below.

Here is what is stated in the report:
The ventricles, cisterns and sulci are appropriate for the patients stated age.  Bilateral deep white matter and periventricular T2 hyperintensities are seen.  With the right centrum semiovale and the frontal and parietal lobes, two, 4.0mm.  T2 hyperintensities are seen.  Another 3.0mm hyperintensity is seen within the frontal subcortical white matter.  In the left peri-atrial region an oval 0.6cm white matter T2 focus is seen.  one to two scattered foci is seen within the parietal lobe deep white matter.

Impression:
Distribution not completely typical for Multiple Sclerosis.
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Avatar_dr_f_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history and review your MRI, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

Hyperintensities are to put it simply white (or bright) appearing signals on specific MRI sequences (such as the T2 sequence). There are multiple causes for such hyperintensities.. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented.

Other causes of plaques in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance. Other causes of plaques on MRI can usually be distinguished based on history and symptoms, such as symptoms of neurologic deficit (for example arm weakness or difficulty walking etc). These can also be distinguished based on the MRI appearance. These include, but are not limited to, multiple sclerosis, other demyelinating disease, and inflammatory processes such as vasculitis.

It is a good idea to discuss the findings on your MRI with your neurologist, to better understand their implications. Also, for continued management of your headaches. If your migraines are not under good control, evaluation by a headache specialist (a neurologist with specialty training in headache medicine) may benefit you.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
7 Comments
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Avatar_m_tn
The radiologist is saying that you have some lesions, but they are not complete typical for MS.

Have you ever had a MRI before?

Do you have any other symptons?
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1079216_tn?1258204405
Thanks for the reply-

I had an MRI of my back earlier this year prior to undergoing surgery for herniated disks.

This is the first MRI I have had of my head.  I just can't seem to get the daily migraines and constant headaches under control.

Other symptoms are visual disturbances such as spots in my vision, feeling unbalanced when my headaches are at their worst, not sleeping well.  I had a sleep study the other night as well.

I've tried all sorts of meds but all they do is reduce not alleviate the symptoms/issues.
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Avatar_n_tn
I am 58 yrs old and have had migraines for 40+ years.  I had my 1st MRI one yr ago.  The results mentioned MS because of the white hyperintensities seen on the MRI.  I consulted a neurologist who said it was the result of migraine "scarring".  I do not have diabetes, high cholesterol, high blood pressure and do not smoke or drink alcohol.  Thankfully, I do not have any MS symptoms.  I go to a nationally know headache clinic.  I wish someone would study this "hyperintensity" with regard to migraine.  I don't know where to turn anymore.

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1079216_tn?1258204405
Thank you for the response.  I wanted to mention in previous migraines that they were controlled but I had issues with the blood vessels in my eyes bursting.  Once this happened I had relief from my migraine.

This is no longer happening and I now have this continual one sided migraine.

I have also been having memory issues, focus issues as well as feeling as if I am always off balance.

I have tremors in the right side of my hand with periodic tingling as well.

I do not have diabetes, high blood pressure, high cholesterol, etc. and am in generally good health otherwise.

I have tried Zomig, Imitrex, Treximet, Frova, Fioricet, Propanalol, Depakote and steroids without relief.  Is there anything else that you can recommend that I can try to see if I can find some comfort?

Thank you again for your reply.
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Avatar_m_tn
All your symptons do seem like Migrains.

Did you try a headache clinic or specialist.

With all those medicine, you could be getting rebound pain

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1079216_tn?1258204405
I saw my primary physician and have now been referred to the Neurologist.  

I haven't been on all those meds in a row, just what has been tried in the past.  Most recently I've been on the Frova, Fioricet and Propanolol.
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