Migraine with aura (MwA) in the emergency setting is common and sometimes difficult to distinguish from mimicking conditions. Susceptibility weighted imaging (SWI), amagnet resonance (MR) technique is sensitive to deoxygenated hemoglobin in cerebral veins and depicts these according to their level of oxygenation. Our study aimed at evaluating the frequency of regions of prominent focal veins (PFV) on SWI in the acute phase. Between 2011 and 2018 we evaluated symptoms and MR imaging of adult patients with acute MwA attacks (< 5days after onset of symptoms). Abnormal imaging was visually scored in 12ROIs on both hemispheres distributed on 3slices. The score ranged from 0 to 3. In all, 638patients (436female) mean age 37.39 years (18-89 ± 14.13) were included. Susceptibility weighted imaging was abnormal in 18.8% of patients. The inferior and posterior medial temporal lobe and the occipital lobe were most often affected. Susceptibility weighted imaging was more likely abnormal when MR was performed within 24hours with an average around 5hours after symptom onset. The side of aura symptoms and hemispheric imaging alteration in patients with abnormal SWI was highly significant (p < 0.001). In the acute episode of MwA, SWI imaging can show acombination of increased deoxygenation. The results may indicate linking PFV to MwA.