What is the role of neuroimaging in the workup of childhood migraine variants (equivalents)?

Updated: Nov 19, 2019
  • Author: Wendy G Mitchell, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Answer

Neuroimaging with computed tomography (CT) or magnetic resonance imaging (MRI) is indicated during the first or worst attack that presents with simultaneous focal neurologic deficits or altered mental status; it should also be done if any focal findings persist between attacks. Perform these studies to exclude other acute causes of the symptoms.

Neuroimaging is less important if the patient presents during a symptom-free interlude, with a history of multiple attacks followed by complete recovery. In these patients, the clinician can usually rule out acute life-threatening conditions and can more reasonably make a diagnosis of migraine on the basis of the history.

During or immediately after an attack, functional neuroimaging may support the diagnosis, though migraine is most often a clinical diagnosis. Single-photon emission CT (SPECT) may show hypoperfusion during an aura or episode. Functional MRI (fMRI), a research technique, also may demonstrate abnormalities of perfusion. Gadolinium-enhanced MRI may show focal enhancement during or immediately after the attack. This can cause confusion with ischemic stroke, inflammatory conditions, or infection.


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