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Q. Does MRI with scattered white matter and hyper intensive areas indicate tension type headache?

Answered by
Dr. Sudheer Ambekar
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 11, 2020

Hello doctor,

I am a 40-year-old female. I saw a neurologist after an MRI due to increasing headaches. She believes they are tension headaches, but my MRI had scattered white matter with hyperintensive areas on it. She noted that they were mild and fairly common and was not worried.

I keep seeing studies linking these hyperintensities to a three-fold higher risk of stroke even in healthier individuals with no other risk factors.

I am trying to figure out why my doctor was not worried. Is there anything you believe that my case is different than the ones in these studies? Or maybe I am missing something or maybe the doctor should be more concerned?

Dr. Sudheer Ambekar

Neuro Surgery Neurology
#

Hello,

Welcome to icliniq.com.

White matter hyperintensities on MRI (magnetic resonance imaging) are not uncommon and are commonly seen in many asymptomatic individuals. They are more often seen in individuals with uncontrolled hypertension.

Mere presence of white matter hyperintensities on MRI does not put anyone at a higher risk of having stroke. I understand that there are studies which may indicate so, but a causal relationship has not been proven to the extent that their mere presence should make us change or start some form of treatment. In the absence of symptoms/signs and other risk factors, the presence of white matter hyperintensities should not make us modify treatment.


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Thank you doctor,

I would say, for a mild presentation like mine, should I do a follow up MRI after a period of time to see if they have changed? Or is it truly no concern?

Dr. Sudheer Ambekar

Neuro Surgery Neurology
#

Hello,

Welcome back to icliniq.com.

For an asymptomatic individual without significant risk factors for stroke, we do not usually do periodic MRI to look for a change in the white matter hyperintensities.

I believe it is of no concern unless someone has one or more of the following.

1. Neurological symptoms other than headache such as weakness or tingling of arms or legs.

2. Uncontrolled hypertension.

3. Age more than 70 years.

4. Strong family history of stroke.

5. Heart disease.

6. Uncontrolled diabetes mellitus.


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