White Matter Lesions and Pediatric Headache

Although T2 hyperintense white matter lesions (WMLs) are associated with migraine headache in adults, we have limited data regarding such an association in children. Elizabeth Ackley, MD, a pediatric neurologist and headache specialist at Children’s Hospital Colorado, conducted a research study to examine pediatric MRI (magnetic resonance imaging) results in children with and without headache.
The study, called Dots and Spots, found that WMLs are common in children overall - and equally common between children with and without headache. Therefore, Dr. Ackley concluded that WMLs in children appear to be incidental and unrelated to headache.
The retrospective cross-sectional study reviewed patients aged 3 to 18 years who underwent pediatric brain MRI for any reason Exclusion criteria included any central nervous system pathology or other characteristics that would affect the appearance of white matter. Using electronic health records, the researchers identified which patients had migraine or other types of headache. Pediatric neuroradiologists reviewed the MRI scans and counted the number of WMLs. Dr. Ackley’s team compared the number of WMLs between the groups with and without headache.
40% of the entire study population had WMLs, and the average number of hyperintensities per scan was 3 to 5. There was no difference between male and female patients. The study found no significant association between children with and without headache, and it also found no correlation between the severity of headache and the number of lesions.
Dr. Ackley hopes the findings will help clinicians confidently explain to families that these spots are common in children, as well as avoid unnecessary testing and follow-up. In addition, she believes the findings may change the way white spots on brain MRI should be highlighted and described in radiologic reports.
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