Rule Out (R/O) Migraine

Steven Thibodeau1, Ellen Grant1

1 Massachusetts General Hospital, Boston, Massachusetts
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A1.7
DOI:  10.1002/0471142719.mia0107s13
Online Posting Date:  May, 2005
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When imaging patients with headaches, the goals are: (1) to rule out a more ominous etiology for their headaches and (2) to assess the degree of hemodynamic and parenchymal involvement when atypical or complicated migraine is suspected. The standard images allow other etiologies, such as mass lesions, to be excluded and an MR venogram can rule out venous sinus thrombosis. Contrast may be helpful in differentiating multiple small metastases, demylinating lesions with inflammatory components, and subcortical infarcts from the nonspecific foci of increased T2 associated with migraines that do not enhance. Perfusion‐weighted imaging allows detection assessment of hemodynamic compromise. Diffusion‐weighted imaging, in combination with the standard MR images, allows assessment of parenchymal involvement. This unit contains a basic protocol which can be used for the evaluation of patients as well as an alternative protocol for the assessment of cerebral perfusion in patients with visual auras.

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Table of Contents

  • Basic Protocol 1: Standard Imaging for Migraine
  • Alternate Protocol 1: Assessment of Cerebral Perfusion in Patients with Auras
  • Commentary
  • Literature Cited
  • Tables
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Basic Protocol 1: Standard Imaging for Migraine

  • Gadolinium‐DTPA contrast agent (e.g., Magnevist, Omniscan, Prohance)

Alternate Protocol 1: Assessment of Cerebral Perfusion in Patients with Auras

  • Gadolinium‐based MR contrast agent (e.g., Magnevist, Omniscan, Prohance)
  • Normal saline (0.9% NaCl), sterile
  • 18‐G angiocatheter and MR‐compatible injection pump
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Literature Cited

Literature Cited
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   Cooney, B.S., Grossman, R.I., Farber, R.E., Goin, J.E., and Galetta, S.L. 1996. Frequency of magnetic resonance imaging abnormalities in patients with migraine. Headache 36:616‐621.
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