In-House MRI in Frisco & Plano: Headaches, Migraine & MS Explained

MRI for Headaches: When It Helps and What to Expect

When headaches change, worsen, or come with other neurological symptoms, you may wonder whether you need an MRI. Sometimes the answer is yes. Often it is not. At North Texas Institute of Neurology, Rheumatology & Headache, our neurology and headache specialists decide on imaging based on your symptoms, medical history, and neurological examination, not as a routine step for every patient.

If an MRI is recommended, many patients can complete it in-house at our Frisco or Plano office, so evaluation, imaging, and follow-up happen with the same care team. *Please note that our in-house radiology service (Frisco Imaging Center) also accepts outside referrals.

What Is an MRI?

MRI (magnetic resonance imaging) uses a strong magnet, radio waves, and a computer to create detailed pictures inside the body. Unlike X-rays and CT scans, MRI does not use ionizing radiation. It is especially useful for viewing soft tissue such as the brain, spinal cord, and nerves.

When Can an MRI Help With Headaches?

For selected headache patients, MRI helps look for an underlying cause, such as a structural abnormality, tumor, infection, or fluid buildup. The goal is usually to rule out these "secondary" causes. MRI is not used to confirm migraine itself.

Your clinician may recommend imaging if:

• Your headaches are getting progressively worse or have changed significantly
• Headaches begin after age 50
• Headaches occur with weakness, numbness, double vision, confusion, or other new neurological symptoms
• Your history includes cancer or a weakened immune system

Can an MRI Diagnose Migraine?

Not directly. Migraine is diagnosed from your symptoms, medical history, and neurological exam. There is no scan finding that confirms it. For patients with migraine, MRI still has an important role:

• Ruling out conditions that mimic migraine. When symptoms are unusual, MRI helps exclude causes such as tumors, stroke, or other structural problems, so your diagnosis and treatment plan rest on solid ground.
• Evaluating atypical or changing migraine. Unusual or prolonged aura, aura with weakness, or a clear change in your usual pattern are common reasons to image.
• Providing reassurance with a clear answer. A normal MRI supports a primary headache diagnosis and lets you and your clinician focus on treatment.

Some people with migraine have small "white spots" (white matter hyperintensities) on MRI. These are common, are usually considered benign, and on their own do not mean something serious is wrong. Your neurologist can explain what any finding means for you, including how it differs from the lesions seen in conditions like multiple sclerosis.

Does Everyone With Migraine Need an MRI?

No. People with a typical, stable migraine pattern and a normal neurological exam generally do not need routine brain imaging. If you have already had a normal MRI and your migraine has not changed, a repeat scan is usually not needed.

A normal MRI does not mean your headaches are not real or serious. It means the scan did not show a structural cause. You may still have migraine or another headache disorder that deserves treatment, and our headache team can help build a plan.

MRI and Multiple Sclerosis

Unlike migraine, multiple sclerosis (MS) relies heavily on MRI for diagnosis. MS is diagnosed using the McDonald criteria, updated in 2024, which combine your symptoms and exam with MRI findings and sometimes spinal fluid testing. MRI of the brain and spinal cord can show the characteristic lesions of MS, and repeat scans help your neurologist monitor the disease and see how well treatment is working.

Because headaches can be a reason someone first gets an MRI, it matters that a neurologist interprets the results. Migraine-related white spots and MS lesions can look similar to an untrained eye, and careful review helps avoid an incorrect diagnosis.

How MRI Helps Other Neurology Patients

Beyond headaches and MS, MRI gives your neurologist a detailed view of structures that cannot be assessed by exam alone. Depending on your symptoms, it may help:

• Evaluate weakness, numbness, seizures, or vision changes
• Identify tumors and stroke-related changes
• Assess spinal cord problems and nerve compression
• Track an established condition and guide treatment decisions

An MRI is one piece of the picture. Your clinician interprets the images alongside your symptoms, history, and exam!

What to Expect During Your MRI

An MRI is painless, though lying still can be uncomfortable for some people.

Safety screening. Our imaging team reviews your medical history and asks about implanted devices, past surgeries, and any metal in your body. You will remove jewelry and metal items and may change into a gown.

Positioning. You lie on a padded table that slides into the scanner. For a brain MRI, a special coil is placed around your head. Staying still helps keep images clear.

Imaging. The scanner makes loud knocking or tapping sounds. You will receive earplugs or headphones. The technologist can see and talk with you throughout, and you will have a way to signal for help.

Contrast, if needed. Some exams use a contrast agent given through an IV to make certain tissues show more clearly. Not every MRI needs it.

A brain MRI usually takes about 30 to 60 minutes. Our team can give you an estimated time for your specific exam.

How to Prepare

Follow the instructions you receive, and let us know ahead of time if you:

• Have a pacemaker, implanted pump, surgical clips, or another implanted device
• Have metal fragments in your body or a history of metalworking injuries
• Are or may be pregnant
• Have reacted to MRI contrast before
• Feel anxious in enclosed spaces or have trouble lying still

Having an implant does not automatically rule out an MRI, but our team needs to review it first. If you are claustrophobic, tell us before your appointment so we can discuss options, which may include IV sedation (oral sedation is not provided). If you receive sedation, plan for someone to drive you home.

After Your Scan

Most patients return to normal activities right away unless they received sedation or other instructions. Your clinician will review your results with you, explain what they mean for your symptoms, and discuss next steps in your care.

Schedule a Headache or Neurology Evaluation in Frisco or Plano

Not every headache needs an MRI, but every concerning headache deserves a thoughtful evaluation. If your headaches are changing, getting worse, or affecting your daily life, our team can help determine the right next step, whether that is imaging, treatment, or both.

Schedule an appointment with North Texas Institute of Neurology, Rheumatology & Headache, or call our Frisco office at (972) 403-8184.

Learn more about our Headache & Migraine care, Neurology services, and in-house Diagnostic Imaging.

Seek emergency care right away for a sudden, severe ("worst ever") headache, or a headache with fainting, seizure, confusion, sudden weakness, or trouble speaking.

Sources

RadiologyInfo.org (ACR/RSNA): MRI of the Head — https://www.radiologyinfo.org/en/info/mri-brain

American Migraine Foundation: Do I Need an MRI for My Migraine? — https://americanmigrainefoundation.org/resource-library/do-i-need-an-mri-for-my-migraine/

American Migraine Foundation: Headache, MRI and Brain Imaging — https://americanmigrainefoundation.org/resource-library/headache-mri-and-brain-imaging/

Cleveland Clinic: Diagnosing MS Using the 2024 McDonald Criteria — https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/diagnosing-ms-using-the-2024-mcdonald-criteria

National Institute of Neurological Disorders and Stroke: Headache — https://www.ninds.nih.gov/health-information/disorders/headache

This article is for general education and does not replace an individualized medical evaluation.