Appropriateness of magnetic resonance angiography in the evaluation of migraine patients
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Appropriateness of magnetic resonance angiography in the evaluation of migraine patients Marco Russo 1 & Gianni De Berti 2 & Arens Taga 3
# Fondazione Società Italiana di Neurologia 2020
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. In a “real-world” setting, many migraineurs undergo both brain MRI and MR angiography (MRA) to exclude, among intracranial pathologies, the presence of underlying vascular abnormalities. Few case-control studies have showed that the prevalence of migraine may be higher in patients with unruptured intracranial aneurysms (UIA) [2], but whether migraine is linked to an increased risk of vascular abnormalities, including UIA, is unclear and literature data are mainly limited to sporadic case reports. In this study we retrospectively analysed all consecutive cerebral MRA studies performed on outpatients being evaluated for a headache disorder at “Villa Verde Polyclinic Private
* Marco Russo [email protected] 1
Department of Neurology, Azienda Unità Sanitaria Locale-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
2
Department of Radiology, Villa Verde Polyclinic Private Hospital, Reggio Emilia, Italy
3
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
Hospital” of Reggio Emilia (Italy) between 2017 and 2019. Villa Verde is a private institution accredited to the Italian National Health system for outpatient and hospitalization. Patients with a clinical diagnosis of migraine with (MA) or without aura (MO) were considered separately and compared with non-migrainous headache (NMH) cases. All the diagnoses were codified by a headache specialist or a neurologist according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). All MRA studies were performed on a 1.5 T unit by using time-of-flight (TOF) sequence. Source images and MIP reconstructions (in doubtful cases also VR reconstructions) were reviewed by four expert neuroradiologists (more than 15 years of expertise each). MRA findings were classified as follows: normal study (NS), normal anatomical variant (NV), UIA, which were further distinguished based on diameter (i.e., < 5 mm, ≥ 5 mm), arterial stenosis/atheromatous disease (AS), and other abnormalities
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