BACKGROUND: Migraine is one of the most common complaints encountered in neurology clinics. Accurate diagnoses of migraine are usually informed by the patient's history, and neuroimaging is only performed in cases of atypical or severe, medically intractable headache to rule out underlying pathologies. Our study aimed to identify the spectrum of brain magnetic resonance imaging (MRI) findings characteristic of chronic headache. METHODS: This retrospective study of adult patients referred to the First Scan radiology clinic in Jeddah, Saudi Arabia, for brain MRI with a known diagnosis of migraine headache was performed between April 2016 to May 2017. RESULTS: We included 275 adults (115 men; median age, 38 years, IQR 30-52) with known diagnoses of chronic migraine. Incidental MRI findings were discovered in 157 (57 %) of the scans; 23 (8.3 %) of these were clinically significant, indicating the need for an intervention. Patients aged >40 years were more likely to have an abnormal scan. There were no significant differences related to sex or duration of headaches for more than one year. CONCLUSION: The performance of brain MRI warrants consideration in patients who do not respond as expected to migraine and headache treatment. We found clinically significant MRI findings in up to 8 % of such patients. Abnormal imaging findings were the most common among patients of >40 years of age.