Appropriateness of magnetic resonance angiography in the evaluation of migraine patients

Excerpt

Indiscriminate use of neuroimaging for migraine diagnosis is a debated issue that every headache specialist has to face because it significantly increases costs for patients and health care systems. A recent guideline from the American Headache Society [1] suggests to consider neuroimaging for presumed migraine diagnosis in the following clinical scenarios: increasing frequency, severity, or change in migraine clinical features; abnormal neurological examination; first or worst ever migraine; unusual or persistent aura; migraine with brainstem aura, confusional migraine, and hemiplegic migraine; late-life migrainous accompaniments and migraine aura without headache; side-locked migraine and posttraumatic migraine. Neuroimaging is not recommended in migraine patients with typical presentation and a normal neurological examination. …