Is it Multiple Sclerosis or Migraine? Understanding White Matter Changes in Migraine Patients.

Headaches are a frequent reason for obtaining brain imaging, specifically MRI scans. While the value of MRI in diagnosing straightforward migraines is limited, these scans often reveal findings that can lead to unnecessary testing or increased anxiety. A common issue reported in MRI results is changes in white matter. If you’ve had an MRI of the brain, you might have encountered a report stating something like this:

“Scattered white matter disease consistent with small vessel ischemic disease. Other considerations including infections (such as Lyme), vasculitis, or demyelinating diseases (such as multiple sclerosis) cannot be excluded.”

This language can sound alarming, but let me reassure you, in most cases, these findings likely do not apply to you. Let’s explore what this means:

What is “white matter”? 

Brain tissue is primarily divided into two types: grey matter and white matter. Grey matter contains the main bodies of our neurons, while white matter comprises the long extensions from these neurons. These extensions appear white due to a fatty layer called “myelin” that insulates them.

What is “white matter disease”? 

White matter disease refers to conditions that alter the appearance of white matter, often showing as “whiter-than-usual” spots on an MRI. Analogous to skin, consider white matter disease like wrinkles on the skin, which can appear due to aging, smoking, sun exposure, or oxidative damage.

Changes in the white matter can result from variations in blood perfusion, damage to the myelin sheath, or changes in hydration, causing the tissue to appear “wrinkled” or brighter on imaging scans.

Why do these changes occur? 

The most common cause of white matter disease is reduced blood flow due to small vessel changes, often associated with aging, hypertension, smoking, or diabetes. However, inflammatory diseases can also impact myelin and alter the appearance of white matter, as seen in conditions like multiple sclerosis or infections.

Why do migraine patients show these changes? 

The reason for white matter spots in migraine patients is still under debate. We know that migraines are not just headaches; they involve complex changes in the brain’s blood supply and electrical activity. These factors likely contribute to the altered integrity of white matter, resulting in visible spots on MRI scans.

Are these the same as those seen in other diseases? 

No, white matter changes vary among different conditions. The changes seen in aging differ from those in multiple sclerosis, and both differ from those associated with migraines. Typically, the white matter changes in migraine patients are fewer and less severe compared to those observed in ischemic conditions or multiple sclerosis.

Implications of these findings: 

Radiologists often mention possible serious conditions in MRI reports to mitigate liability, even though these findings are commonly seen and usually not indicative of severe disease. It is crucial to discuss any concerning MRI findings with your neurologist to determine their relevance to your specific situation.

Are there long-term risks associated with these MRI findings in migraine patients? 

Current knowledge does not establish a link between white matter spots in migraine patients and serious long-term consequences such as stroke or cognitive decline. Additionally, treatment decisions for migraines do not appear to influence the development or progression of these spots.

In conclusion, the white matter spots identified in migraine patients’ MRI scans are generally considered benign. If your report mentions potential diseases, it is advisable to consult with your neurologist to clarify whether these observations are relevant to your health situation.

More tips, tricks and updates on headache? subscribe here