White Matter Hyperintensity on MRI in Migraine

White matter hyperintensities (WMH) on MRI (T2W and FLAIR sequences) are seen in several conditions. The most common among them (from more common to less common) are: 1. Migraine, 2. Small vessel ischemia, 3. Multiple sclerosis

Here you can see a FLAIR MRI image showing periventricular hyperintense lesions (right more than left) in a 25-year old woman with a 2-year history of migraine without aura.

So, if you see multiple white matter lesions on MRI, do not think of multiple sclerosis in all cases. In younger people, consider migraine, and consider small vessel ischemia in older people, especially those with high BP or diabetes.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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