Migraine Expert Says Imaging Is Not a Substitute for Patient Care

By AI, Created 4:27 PM UTC, May 18, 2026, /AGP/ – Headache specialist Egilius L.H. Spierings says new MRI and biomarker research may help migraine science, but doctors should not treat patient-reported symptoms as guesswork. He argues current migraine care is already effective and that the future should balance technology with clinical judgment.

Why it matters: - Migraine affects about 15% of the global population, so how doctors diagnose and treat it has wide real-world impact. - Dr. Egilius L.H. Spierings says overreliance on imaging and biomarkers can push patient experience to the side, even though symptom reports remain central to care. - The debate matters because treatment decisions shape quality of life, missed work, and long-term disease burden for millions of patients.

What happened: - Dr. Egilius L.H. Spierings, a headache-and-face-pain specialist, pushed back against claims that migraine treatment is “pretty much guesswork.” - His comments came after a Stanford Medicine study, reported by Medical Xpress, suggested functional MRI scans may help identify biological migraine subtypes and improve treatment decisions. - Dr. Spierings said the discussion is drifting too far toward brain imaging and away from listening to patients.

The details: - Dr. Spierings said many disorders are diagnosed and treated based on a patient’s symptom description, and migraine should be no different when clinicians listen carefully. - He argued that lab findings, imaging and biomarkers are gaining too much influence compared with patient-reported experience. - Dr. Spierings said patients often know what is wrong with them and physicians should analyze that information without needing biomarkers to validate it. - Migraine is commonly classified as with or without aura, and as episodic or chronic based on headache frequency. - Dr. Spierings said those categories alone should not determine whether preventive treatment is needed. - Preventive treatment depends on overall headache burden, how well abortive treatments work, and whether the patient wants prevention. - Dr. Spierings criticized older migraine treatments cited in the study, including beta-blockers and anticonvulsants, as often poorly tolerated and only modestly effective. - He identified CGRP-targeted medicines, including CGRP antibodies and gepants, as the current standard of care. - Dr. Spierings said those newer treatments are generally very well tolerated, extremely safe and highly effective. - He said medicine should not lose sight of the patient sitting in front of the doctor. - More information is available here.

Between the lines: - Dr. Spierings is not rejecting research; he is arguing against using early imaging findings to overshadow day-to-day clinical judgment. - His comments suggest a broader tension in medicine between high-tech diagnostics and bedside evaluation. - The criticism also reflects concern that calling migraine care “guesswork” could erode patient confidence in treatment that already works for many people.

What’s next: - Migraine research will likely continue exploring MRI-based subtypes and biomarkers. - Dr. Spierings expects future care to combine scientific advances with stronger attention to patient-reported symptoms and physician expertise. - He is available for interviews as the debate over migraine diagnosis and treatment continues.