AIIMS-trained neurologist shares 5 serious reasons why you might have severe headaches even with a normal MRI

Neurologist Dr Chawla identifies 5 reasons for severe headaches despite normal MRIs, emphasising that the results do not rule out primary headache disorders.

A headache is a pain in your head or face that's often described as a pressure that's throbbing, constant, sharp or dull. Often, with severe and persistent headaches, one generally consults a doctor, who then suggests an MRI. But what if your MRI comes back normal and the headaches persist; what then?

Dr Rahul Chawla, a neurologist trained at AIIMS Delhi and Safdarjung Hospital, shared on October 8, via an Instagram post, the five reasons why you might experience severe headaches even after a normal MRI. Let's find out:

5 reasons you might have headaches even with a normal MRI

Sharing the 5 reasons, Dr Chawla wrote, “MRI looks normal, but still having severe headaches? It can be more serious than you think.” These are the 5 reasons he shared in the post that explain why you might have headaches.

1. Migraine

A primary neurovascular disorder, migraine, according to the neurologist, is caused by “abnormal excitability of the trigeminovascular system and serotonin imbalance.” He explained, “Since the brain structure is intact, MRI remains normal even during severe attacks.”

2. Tension-type headache

A severe headache could also be triggered by stress, anxiety, or prolonged posture, according to Dr Chawla. He explained, “This headache arises from muscle tension and central sensitisation. There’s no anatomical lesion, so the MRI shows no abnormality.”

3. Medication overuse headache (MOH)

“Frequent use of painkillers, triptans, or caffeine-based drugs can desensitise brain pain pathways and cause daily headaches, despite a completely normal scan,” Dr Chawla explained.

4. Hypertension-related headache

“Poorly controlled blood pressure, especially early morning surges, can cause vascular distension and occipital pain,” he stated.

5. Refractive error and eye strain

Lastly, uncorrected vision issues or prolonged screen exposure can also cause severe headaches, as it leads to fatigue of the ocular muscles and causes frontal headaches.

Apart from these five reasons, the neurosurgeon also shared other causes that may be causing you a severe headache without being detected on an MRI. They are:

• sinusitis
• stress
• anxiety
• depression
• sleep deprivation

The neurosurgeon highlighted that they can trigger or worsen chronic daily headaches by altering the brain’s pain-processing circuits, even though imaging remains normal.

Lastly, he mentioned, “A normal MRI only rules out structural lesions like tumours or bleeds, not primary headache disorders or functional or other systemic causes. Always consult a neurologist for persistent headaches or unclear diagnoses.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

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