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History of hypertension and severe migraine. Brain MRI says hyperintense FLAIR signal focus in periventricular white matter. Meaning?

Nov 2013
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Hi, I'm a 37 female with history of mild hypertension and severe migraine episodes. I went to a Neurologyst and he order a brain MRI w + w/o Gadolinium. In the findings the radiologist says "In the right frontal periventricular white matter, there's a 3mm hyperintense FLAIR signal focus. In the left frontal subcortical white matter, there's a smilar hyperintense FLAIR signal focus" IMPRESSION: Hyperintense FLAIR signal focus in the right frontal subcortical white matter respectively,most likely representing chronic microvascular ischemic changes"

3 months ago my left eye suffer from steady ptosis, wich only occurs in severe migraine episoides and when I felt relieve it gone. Do you think my ptosis is related to the MRI results????
Posted Sat, 10 Aug 2013 in Headache and Migraines
Answered by Dr. Sudhir Kumar 52 minutes later
Thank you for posting your query.

First of all, I would like to reassure you that the MRI findings do not represent any serious brain disease.
These findings commonly occur in patients with chronic migraine. This is due to small areas of ischemia (lack of blood flow) to brain. As long as there are no other risk factors (such as smoking, high cholesterol, use of oral contraceptive pills, high BP, sugars, etc), there is no risk of brain stroke.

Ptosis can occur with migraines, however, the MRI findings are not related to Ptosis.

As of now, you require treatment to prevent migraine headaches and nothing else. Medications that help include Topiramate, beta blockers, etc. Your primary care doctor will know about these medications.

I hope it helps.
Please get back if you have any more queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
Follow-up: History of hypertension and severe migraine. Brain MRI says hyperintense FLAIR signal focus in periventricular white matter. Meaning? 9 hours later
So...I'm at risk because I have hypertension too. Then, what are the chances for me suffering a TIA or more than that??? Theres times I have migraines and my BP is high, but not always.Sometimes I think my HBP cause me the migraines too. I know HBP can cause migraines, but I also know extreme pain alters your vital sings specially BP.

I'm already in a preventive treatment, Elavil 25mg daily but my head physician (IM) thinks I have better chances with Topamax....but I've read it can cause seizures it patients without history of convulsions. And I am...still suffering from migraines. :'(
Answered by Dr. Sudhir Kumar 12 minutes later
Thank you for getting back with more details.

There is no need to feel depressed, as the risk is very little. I see more than 100 patients with migraine every month (for the past 15 years), and about 10% have these lesions on their MRI. But less than 10 patients have suffered TIA/brain stroke out of that.

I feel topamax is good for you and safe too, the risk of fits/convulsions is very little, and I have not seen any (out of more than 1000 patients treated with that).
Cheer up please....

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
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