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Unusual Brain MRI Findings in Patients Imaged for Headache: a Case Series

  • Uncommon and/or Unusual Headaches and Syndromes (J Ailani, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We describe a series of cases with unusual brain MRI findings in patients who present with headache disorders.

Recent Findings

Incidental findings in patients imaged for headache include the following: aneurysm, arachnoid cyst, cerebral vascular malformations, Arnold-Chiari malformations, empty sella turcica, gray matter heterotopias, mastoiditis, mega cisterna magna, meningioma, normal variants of cerebral circulation, paranasal sinus disease, pineal cyst, pituitary tumor, Rathke’s cleft cyst, skull hyperostosis, and vestibular schwannoma. The most common abnormal MRI findings encountered in migraine are nonspecific white matter lesions.

Summary

The current 2019 guidelines from the American College of Radiology and American Headache Society recommend against ordering neuroimaging in patients with a high probability of a primary headache disorder not typically associated with diagnostic imaging findings and who have normal neurologic exam in addition to no red flags in history. Often, unnecessary neuroimaging yields incidental findings, and this typically results in patient anxiety and further unnecessary testing. Detailed below are a series of cases in which unusual findings were found in patients presenting to our clinic for further evaluation of headache disorders. Imaging may have been done prior to presentation to us or by us due to concern for secondary causes.

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Author information

Authors and Affiliations

  1. Jefferson Headache Center, 900 Walnut Street Suite 200, Philadelphia, PA, 19107, USA

    Yadira Flores-Montanez

  2. Director, Headache Medicine Fellowship Program, Jefferson Headache Center, 900 Walnut Street Suite 200, Philadelphia, 19107, PA, USA

    Stephanie J. Nahas

  3. Assistant Director, Neurology Residency Program, Jefferson Headache Center, 900 Walnut Street Suite 200, Philadelphia, PA, 19107, USA

    Stephanie J. Nahas

Authors
  1. Yadira Flores-Montanez
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  2. Stephanie J. Nahas
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Corresponding author

Correspondence to Yadira Flores-Montanez.

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Conflict of Interest

Yadira Flores-Montanez declares no conflict of interest.

Stephanie Nahas reports serving on the advisory board for Alder/Lundbeck, Allergan, Amgen/Novartis, Biohaven, Eli Lilly, Impel, Supernatus, Teva, Theranica, and Zosano. She reports receiving personal fees as a speaker from Amgen/Novartis, ElectroCore, Eli Lilly, Supernatus, and Teva; and personal fees as a consultant for Allergan, Alder/Lundbeck, Biohaven, Impel, Eli Lilly, and; non-paid consultant work for Supernus, Teva, Theranica, and Zosano.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Uncommon and/or Unusual Headaches and Syndromes

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Flores-Montanez, Y., Nahas, S.J. Unusual Brain MRI Findings in Patients Imaged for Headache: a Case Series. Curr Pain Headache Rep 24, 51 (2020). https://doi.org/10.1007/s11916-020-00881-9

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  • DOI: https://doi.org/10.1007/s11916-020-00881-9

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