Brain scans can give your healthcare team valuable information about the status of your neurological health (the health of your brain and nervous system). Magnetic resonance imaging (MRI) scans are painless imaging tests that use magnets and radio waves to create detailed pictures of the brain and its structures.

If you live with a neurological condition like chronic migraine, your doctor may recommend a brain MRI to help rule out other causes of your symptoms or better understand your condition.

You might wonder how your MRI scan compares to that of someone who doesn’t have migraine. In some cases, MRI results may look similar. In others, there may be small differences. It’s also important to know that unusual MRI findings don’t always mean migraine is the cause: They may be linked to other health conditions.

What Healthcare Providers Might See on an MRI Scan

Most people with migraine have typical MRI scans without unusual features. For this reason, doctors don’t usually recommend a brain MRI just because someone has migraine attacks. Instead, an MRI is typically ordered when there are other symptoms or concerns that need to be checked.

Migraine headaches are usually a type of primary headache (a headache not caused by another underlying condition). Therefore, the chance of finding something unexpected on a brain MRI is low. Still, in some cases, certain changes may appear on a scan.

White Matter Lesions

Studies have found small areas called white matter lesions (also known as white matter hyperintensities) in some people with migraine. These appear as bright spots on an MRI scan. How common they are can vary depending on the group of people studied and the type of MRI used.

Doctors often consider them to be benign (not harmful), and they usually don’t require follow-up imaging, unless there are other concerning symptoms.

In some cases, white matter lesions may be linked to a rare genetic condition called CADASIL, which stands for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Migraine attacks can sometimes be an early sign of CADASIL.

However, most people with white matter lesions do not have a genetic condition or a clear cause. These spots can also be seen in people who do not have migraine.

Some research suggests white matter lesions may be more common in people who:

• Have migraine with aura (sensory symptoms like flashing lights or tingling before a headache)
• Have had chronic migraine over many years
• Experience frequent migraine attacks

Dilated Veins

A brain MRI may sometimes show dilated (widened) veins. This finding is uncommon and is most often reported in people with hemiplegic migraine, a rare subtype of migraine with aura.

Hemiplegic migraine can cause symptoms that may look similar to a stroke, such as weakness on one side of the body or trouble speaking. Because these symptoms overlap with serious conditions, doctors may use imaging like MRI to help rule out other causes.

When Your Doctor Might Recommend an MRI for Migraine

Having migraine attacks alone usually isn’t a reason to get a brain MRI, especially if your symptoms follow a familiar or predictable pattern. However, your doctor may recommend a brain scan if something about your symptoms changes or raises concern.

New Neurological Symptoms or Medical Findings

Any new neurological symptoms may be a reason for your doctor to order a brain MRI. These changes could indicate another condition that needs to be ruled out.

“I had a brain MRI today, as I’ve been having neuro symptoms that aren’t necessarily from migraines,” shared a MyMigraineTeam member.

You may notice symptoms yourself, or your doctor might see signs during a physical exam. They can include:

• Confusion
• Vision changes, like diplopia (double vision) or vision loss
• Swelling of the optic nerve (the nerve that connects the eye to the brain)
• Unusual pupil changes
• Weakness on one side of your body
• Sudden poor balance or an unsteady gait (difficulty walking steadily)

Changing Headache Patterns

“I had a brain MRI due to the increase in my headaches,” shared a MyMigraineTeam member. “It looks normal, but my headaches are worse. How can this be?” This example shows how a change in headache patterns can lead a doctor to recommend a brain MRI.

Your doctor may suggest a brain MRI if your migraine headaches:

• Have increased in frequency
• Have become more severe
• Change with movement, such as getting worse when standing up after lying down
• Don’t go away or last longer than usual
• Include aura that lasts longer than one hour

Changes in your usual migraine pattern may suggest a secondary headache (a headache caused by another underlying condition). In these cases, your doctor may order imaging to rule out other possible causes.

Other Red Flags

Your doctor might recommend imaging tests of the brain if you experience migraine headaches under some specific circumstances or with other health conditions. Red flags that require further evaluation with imaging tests include:

• New headaches starting when you’re over 50 years old
• Headaches with fever
• Headaches that don’t improve with any prescription medications
• Headaches that appear after a brain injury
• Headaches in anyone who is immunocompromised (weakened immune system)
• Headaches that occur during specific activities, like when you lift something heavy, cough, bend over, or have sex

What Your Findings Might Mean

Healthcare professionals often want to explore any unusual, changing, or sudden migraine symptoms because these changes can sometimes point to other conditions affecting the brain. Even findings like white spots, which have been associated with migraine, may also be related to aging or other factors.

Migraine-Related Findings

There are no MRI findings that can confirm a diagnosis of migraine. Instead, MRI scans are mainly used to help rule out other conditions that could be causing symptoms or contributing to headaches.

Seeing white matter lesions on an MRI may feel concerning, but current research suggests these spots usually aren’t linked to serious neurological or cognitive (thinking and memory) problems.

Other Brain Conditions

MRI scans provide detailed images of the brain’s structure, which can help doctors look for other possible causes of symptoms. A doctor or radiologist (a specialist who reads imaging scans) may check for signs such as:

• Inflammation (swelling in brain tissue)
• Increased pressure in the brain
• Hemorrhage (bleeding in the brain)
• Changes in brain structure or shape
• Fluid leaks
• Abnormal growths or masses

If your doctor recommends an MRI because of new or changing symptoms, they will review the results with you, often within a day or two. Many abnormal MRI findings are not serious, but imaging can also help detect conditions such as:

• Multiple sclerosis (a condition that affects the nervous system)
• Cerebral vasculitis (inflammation of blood vessels in the brain)
• Stroke
• Effects of hypertension (high blood pressure)
• Blood clots
• Brain aneurysm (a weakened area in a blood vessel that can bulge)
• Meningitis (inflammation of the lining around the brain and spinal cord)
• Concussion
• Brain tumor

Identifying conditions like these on an MRI can help you and your doctor start the right care as early as possible. In some cases, your doctor may recommend follow-up imaging or additional tests if the results are unclear.

Talk to Your Doctor

If you notice any changes in your migraine attacks, let your doctor know. Keeping a migraine diary or journal (a record of when headaches happen and what they feel like) can help you track patterns. You might include notes about how often your headaches occur, how severe they are, and any symptoms you experience.

It can feel frustrating if a brain scan doesn’t provide clear answers. However, a brain MRI can still be helpful because it can rule out serious causes of changes in your headache patterns.

It’s also important to know that MRI scans are not needed to diagnose migraine. A normal MRI result does not mean your migraine isn’t real. Even if your brain imaging looks normal, your healthcare team can work with you to identify migraine triggers (things that may bring on a migraine attack) and find ways to manage your symptoms.

Join the Conversation

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