Q. MRI report for migraine says minimal microvascular changes. What does it mean?

Answered by
Dr. Anshul Varshney
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 29, 2018 and last reviewed on: Sep 16, 2020

Hello doctor,

I am 52 years old and had an MRI for worsening migraines for the last six months. I have had migraines for 31 years. The finding was a few foci of T2 and 3 mm T2 prolongation within the left frontal subcortical white matter. No associated restricted diffusion or abnormal enhancement. No additional parenchymal signal abnormality. The ventricles and midline structures are of normal appearance.

Impression or conclusion: Minimal left frontal chronic microvascular ischemic changes. No findings of an acute intracranial process or abnormal enhancement. What does all this mean? My neurologist said to take seizure medicine for the migraines and my brain is fine. Currently, I am taking 12.5 mg of Amitriptyline every day and Sumatriptan when needed.



Welcome to icliniq.com.

See, your MRI report is normal (attachment removed to protect patient identity) and has nothing to get worried. I would like to know a few things:

  1. Explain your headache. It is onset, severity, site. Any associated vomitings? Its frequency?
  2. How does your migraine improve?
  3. Which seizure medicine you are taking? Is it Topiramate?

Revert with the asked details for a better help.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

I am not taking the seizure medicine. I am going through perimenopause, so I think that is what is making them worse. My migraine starts very fast now, usually on right side of head over eyebrow. I have to take 100 mg of Sumatriptan and six Tylenol to stop. I used to have two in a month, and last month had 13. How is the MRI normal? Do many 52 year olds have the same findings? Does it mean I have had small strokes on the left side, and something is wrong with white matter?



Welcome back to icliniq.com.

It is unlikely to be due to ischemic changes in your brain. This looks like a migraine headache to me. Moreover, a positive response to Sumatriptan and Tynelol favors the diagnosis of a migraine. Menopause can cause precipitation of a migraine. I would recommend in such case scenario to start on tablet Flunarizine 10 mg daily at bedtime and very soon, your migraine headaches would disappear.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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