The role of the clinician in interpreting conventional neuroimaging findings in migraine patients.

Changes in cerebral white matter at CT or MRI have been reported in patients with migraine, especially in those with migraine with aura. Similar pictures may be present in asymptomatic subjects, and their nature is not completely understood, but their infarct-like nature is strongly suggested. Clinicians play an important role in the evaluation of those migraine patients in whom these nonspecific abnormalities are present. We suggest ruling out specific syndromes in which migraine attacks are associated with white matter changes (CADASIL, MELAS, multiple sclerosis and central nervous system vasculitis), as well as evaluating the presence of different vascular risk factors (genetic prothrombotic factors, patent foramen ovale, use of oral contraceptives, etc.). Their possible causative role in MRI lesions and in enhancing the risk of a negative clinical evolution must be considered in each individual case.