MRI - (Migraines, Hallucinations). Interpretation, options?

[Miguel_K]

I'm concerned about some MRI results, and I know I need to confer with a neurologist however if possible, I would like some basic clarification on the MRI report as well as any opinion you may have.

I had multiple surgeries for Craniosynostosis as an infant. I've had a constant dull pain in my head in addition to frequent and consistent migraines (classic without aura) my entire life (including childhood). I also hallucinate frequently (not due to a psychotic break or Schizophrenia etc according to a variety of psychiatrists). This includes erratically shaped shadows and patterns which move (particularly on large areas of plain color or densely patterned objects), after-images, long trails from objects in motion, glowing auras radiating from objects etc. The psychiatrists wanted me to see a neurologist as a wide variety of the medications they tried did not help the hallucinations whatsoever (some were made worse i.e. by Risperdal, Perphenazine etc) and I've NEVER had a psychotic episode.

The MRI report says:

"Sequela of remote bifrontal craniotomy noted. Associated susceptibility artifact is seen, but no evidence of extra-axial fluid collection or associated brain parenchymal changes."

"There are several punctate scattered foci of subcortical white matter T2 prolongation seen bilaterally, nonspecific but may be the sequela of migraines, chronic small vessel ischemia, prior infection or inflammatory process, or other cause of gliosis."

"Chronic inflammatory paranasal sinus disease."

Without a proper history and the MRI images themselves, I understand a proper diagnosis is difficult however I would very much enjoy your opinions on this matter and any clarification/meaning of the MRI results you can provide. If you have any advice for what my next steps in treatment should be I would be grateful.

For the note, I've been taking medications for migraines since being a child without significant success (nearly 40 different medicines) and am currently taking Opioids which I would VERY much like to not have to use but unfortunately I've seen the best results in terms of being able to function somewhat normally from these addictive medications. Hallucinations are NOT medication related.

Thank you very much for your time and consideration!