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How does migraines show up on MRI's?
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How does migraines show up on MRI's?

I just recieved a call from my neurologist saying my MRI showed sinus inflamation (inflammation) and signs of migraines.  From what I found on the internet is that migraines activities can not be diagnosed from an MRI.  If this is true what may the neurologist be seeing.  My symptoms are pain behind my right eye only, right eye twitching, headaches/pressure on my right of my brain which, vertigo, that happens when I turn to the right or bending down, right side of my face does not go numb but sure feels different from the other side.  I went to the eye docter. He said everything looks great. My vision is ok.  That made me happy.  I just need some ideas so I can ask the nuerologist.
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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 are nor what your MRI findings mean. However I will try to provide you with some useful information.

Migraine and other primary headache disorders (such as cluster headache or paroxysmal hemicrania, which are both headache types that cause pain behind the eye) are a clinical diagnosis, made from the history and physical examination. The MRI is used to exclude secondary causes of headaches such as tumors etc., and is not used to diagnose migraine. However, in some patients with migraine, plaques in the brain can be found on MRI. These are usually inconsequential, though their exact significance is unknown.
Your symptoms could be due to migraine, in some types of migraine vertigo can occur, though your vertigo could also be due to an inner ear problem.

There are multiple causes for so called plaques in the brain. 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 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.

In your case, the most likely causes are that the plaques are due to either the migraines, and are therefore likely inconsequential, or they are due to chronic small vessel disease if you smoke, have high blood pressure, high cholesterol, or diabetes. In that case it is imperative that you stop smoking, take medication to control your blood pressure, cholesterol, and diabetes, eat a healthy diet, and exercise.

The different causes can be determined to some extent by interpretation of various sequences of the MRI. Other investigations are sometimes necessary to distinguish the various causes of white matter lesions.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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