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MRI of Brain showed several focal nonspecific white matter T2 and FLAIR hyperintensities. Have severe migraine. Suggestions?

Nov 2013
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Practicing since : 1994
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Hi I had a MRI of Brain with & without contrast conclusion states several focal nonspecific white matter T2 and FLAIR hyperintensities scattered through both cerebral hemispheres. Diagnostic considerations are sequel of chronic microconvascular ischemic changes, vasculitis or demyelination of other etiology to include multiple sclerosis plaques in appropriate clinical setting. I've been having severe migraines for the past 6 weeks with no releif even from migraine medicine. My neurologist is having hip surgery today and I just got my results and I just don't know what to do I'm at my witts end with the migraines nothing has stopped them.
Posted Wed, 16 Oct 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 11 minutes later
Brief Answer:
These MRI findings could occur in migraine.

Detailed Answer:

Thank you for posting your query.

I have read your case details and the MRI report. I would like to reassure you that these MRI brain findings are not suggestive of any serious brain disease. These findings are common in patients with chronic migraine, especially if the migraine is not under good control.

You require good medications for migraine prevention, such as beta blockers, flunarizine, Topiramate, or divalproex. About 60% patients respond to one or more of these medications. If you do not improve, then, Botox therapy may be considered.

In addition, there is a small possibility of these MRI changes being due to ischemia (lack of blood flow to brain). So, you should get screened for high BP, sugar, cholesterol, etc.

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: MRI of Brain showed several focal nonspecific white matter T2 and FLAIR hyperintensities. Have severe migraine. Suggestions? 8 minutes later
I am already on beta blockers topamax and botox every 3 months. so that is what makes this even more scary for me because I've had the headaches under control with all that. Now its been 6 weeks and I can't make them stop. imitex, zomeg, some sort of shots they gave me to take at home, trigger point shots they gave me in the office. Everything works for an hour or 2 then the headache is back.
Answered by Dr. Sudhir Kumar 14 minutes later
Brief Answer:
Your headaches are really refractory.

Detailed Answer:
Thank you for getting back and sharing more information.

I agree that your headaches are really refractory as you are taking three different medications (Topiramate, beta blockers, Botox).

Therefore, it is important to exclude alternative diagnosis, most likely ischemia (lack of blood flow to brain). In addition to sugar, BP and cholesterol, please also check serum homocysteine level, as higher levels could lead to ischemia.

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