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History of migraine. MRI showed small vessel disease and mild chronic leukoencephalophy. Worrisome

Nov 2013
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I have a history of daily migraines for the past 10 months. A recent MRI report stated "small vessel disease" and "mild chronic leukoencephalophy" Could this be the cause of my migraines and and do I need to worry much about the mild leukoencephalophy? Headachs are usually without XXXXXXX but occasionally they are, lightening bolts and sometimes a numbness and tingling on my face. Strong family history of migraines.
Thu, 20 Dec 2012 in Brain and Spine
Answered by Dr. Sudhir Kumar 3 hours 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.

Small white matter ischemic (decreased blood flow) changes on MRI are fairly common in migraine. There is no need to worry about them. For frequent migraine, you should take preventive medications such as Topiramate, beta blockers, etc.

However, small vessel disease could also represent a future possibility of getting brain stroke. So, you require evaluation for any risk factors for the same, such as high BP, diabetes, cholesterol and elevated homocysteine. If they are present, you would require treatment. In addition, you may require aspirin.

I hope it helps. Please get back if you have any more queries.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
Follow-up: History of migraine. MRI showed small vessel disease and mild chronic leukoencephalophy. Worrisome 1 hour later
I have been seen at a headach clinic and have tried topirimate, venlafaxine, several others and now trying Wellbutrin. My headaches are still daily but have decreased in duration. My next question is does the migraines cause the ischemia or vice versa or just what is the correlation. Any other advice. I appreciate the second opinion.
Answered by Dr. Sudhir Kumar 1 hour later
Thank you for getting back with more details.

I think I was not clear enough. The ischemic lesions on MRI brain are caused by migraine. It is not that ischemic lesions cause migraine. This is known because many patients with migraine have normal MRI brain to begin with, and ischemic lesions appear later after a few years of migraine headaches.

At the same time, as I mentioned earlier, these ischemic lesions are not of any serious clinical significance in most patients. However, in some people who have other risk factors (as mentioned in my initial reply) or those who smoke, have a higher risk of getting brain stroke.

I hope it clarifies.

Best wishes,

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