Rule Out (R/O) Migraine

When imaging patients with headaches, the goals are: (1) to rule out a more ominous etiology for their headaches and (2) to assess the degree of hemodynamic and parenchymal involvement when atypical or complicated migraine is suspected. The standard images allow other etiologies, such as mass lesions, to be excluded and an MR venogram can rule out venous sinus thrombosis. Contrast may be helpful in differentiating multiple small metastases, demylinating lesions with inflammatory components, and subcortical infarcts from the nonspecific foci of increased T₂ associated with migraines that do not enhance. Perfusion-weighted imaging allows detection assessment of hemodynamic compromise. Diffusion-weighted imaging, in combination with the standard MR images, allows assessment of parenchymal involvement. This unit contains a basic protocol which can be used for the evaluation of patients as well as an alternative protocol for the assessment of cerebral perfusion in patients with visual auras.