Routine Neuroimaging Rarely Alters Diagnosis, Management in Pediatric Migraine

Most pediatric patients with migraine have normal neuroimaging results, and among those with abnormal findings, none required medical intervention or changes to their migraine management. according to study results presented at the 2025 American Headache Society (AHS) Annual Scientific Meeting, held from June 19-22, in Minneapolis, Minnesota, and virtually.

Among children and adolescents, migraine is the second most common primary headache disorder. After receiving a migraine diagnosis, the families of the patients are often concerned about structural causes of the symptoms. However, previous studies found that only 21% of pediatric patients with primary headache had abnormal neuroimaging outcomes, indicating limited clinical utility of undergoing a neuroimaging assessment.

To assess whether neuroimaging may have clinical utility in pediatric migraine, researchers from Barrow Neurological Institute at Phoenix Children’s in the United States retrospectively reviewed records of patients (N=165) who were diagnosed with migraine and underwent magnetic resonance imaging (MRI) at their center between 2021 and 2023.

Nearly a quarter of patients (24%) had abnormal neuroimaging outcomes.

Among patients with abnormal findings, the reasons for undergoing MRI were worsening headache (29%), new-onset headache symptoms (27%), atypical headache location (9%), and transient symptoms or aura (7%).

The observed abnormal outcomes were white matter hyperintensities (43.59%), anatomic variant (41.03%), cyst (35.90%), pituitary abnormality (15.38%), and a combination of these 4 outcomes (33.33%).

Most abnormal MRI outcomes were incidental and only 4 patients were referred for additional assessments.

No significant clinical interventions were indicated after additional assessment and no patient had a change to migraine management.

This study was limited by the lack of MRI data for 155 patients diagnosed with migraine at Phoenix Children’s.

“Although incidental findings were discovered with imaging, no significant abnormalities were found, which reinforces the notion that routine imaging does not diagnose or change the management in migraine patients,” the researchers concluded.