Are brain imaging studies used to diagnose migraine?


In many cases, neuroimaging of the brain, including tests such as CT scans or MRIs, is not necessary in adequately diagnosing migraine. However, sometimes it is used and can be an important part of the therapeutic process of diagnosis and establishment of subsequent treatment.


“I think neuroimaging plays a big role in headache. It does in diagnosis. Despite what I said about localization, imaging has proven that classical neurology may be wrong at times. It's very important to use tests as an extension of the history and physical. By and large, if you've done a proper history, both to include the history of the illness, past history, medical history, social history, and a neurological function inquiry to examine parts of the brain, then a good examination, done properly, should lead you to the probability that the patient doesn't have a serious secondary cause for headache. By and large that's true, because about 90% or more of headaches are not of serious, life threatening diagnostic nature. It's
that 10% that can be difficult. By the time it's all done, most times, in theory you don't have to do neuroimaging. What happens, however, is a patient may arrive at the consultant's
office, sent by a family doctor, and already have the imaging done. Then the question is if they've done a CT, would you like to do an MRI, etc. Sometimes we do, in part, because the patient is worried that there's something serious going on in their brain. Even though
logically we think that's unlikely, we know that emotionally we all feel that there's something wrong. In that regard, I consider it a test; the neuroimaging is part of the therapeutic process. In fact, if you can't get around that uncertainty with talking to the patient, it may be necessary to move on to a test. Not necessary to always add in dye, or other things that may have risks, but very important to let the patient know that you understand that that's a reasonable question.”

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Allan Purdy, MD

Professor of Neurology
Dalhousie University, Canada

Dr. Allan Purdy is a neurologist and a professor at Dalhousie University in Nova Scotia, Canada. Dr. Purdy is currently President of the American Headache Society. He has also served as president of the Canadian Headache Society and on the Board of Directors for the International Headache Society.

Dr. Purdy is regarded as one of the most gifted teachers in the field, developing educational programs for physicians around the world who care for patients with headache diseases. In addition to his research and education work, Dr. Purdy continues to see headache patients in his Canadian clinic on a part-time basis.