Background: Incidental T2 white matter hyperintensities (WMHs) in headache patients on brain magnetic resonance imaging (MRI) may prompt concern for demyelinating disease.
Objective: We reviewed brain MRI studies in patients with headaches without known demyelinating disease to determine the prevalence meeting imaging criteria for multiple sclerosis (MS) using two different definitions of "juxtacortical" and "periventricular".
Methods: Consecutive patients undergoing pre- and post-contrast MRI for headaches over a 25-month period were retrospectively identified. Exclusions included patients under age 10 and over 55 years or with known demyelinating disorder. Patients were classified as meeting: 1) Barkhof and 2) 2010 McDonald dissemination in space criteria for MS based on: FLAIR/T2 scans for WMH and enhanced T1-weighted images for enhancement. Both groups were further differentiated by defining "periventricular" and "juxtacortical" as WMH contacting ventricle and cortex (Barkhof "touching", McDonald "touching") versus WMH within 3 mm (Barkhof--3 mm, McDonald--3 mm).
Results: 326/564 (58%) studies met inclusion criteria. WMH prevalence was 168/326 (51.53%). Barkhof "touching" criteria were met in 4/168 (2.4%) and in 12/168 (7.1%) of the 3 mm group. McDonald criteria were met in 41/168 (24.4%) for "touching" and 58/168 (34.5%) for 3 mm, respectively.
Conclusion: Barkhof and McDonald criteria were met in 2.4-7.1% and 24.4-34.5%, respectively.
Keywords: Multiple sclerosis; clinically isolated syndrome; fluid attenuation inversion recovery; magnetic resonance imaging; radiologically isolated syndrome; white matter hyperintensity.