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Migraine with aura is associated with an incomplete circle of willis: results of a prospective observational study

Brett Cucchiara1, Ronald L Wolf, Lidia Nagae

  • 1Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. cucchiar@mail.med.upenn.edu

Plos One
|August 8, 2013
PubMed
Abstract

Insights

An incomplete circle of Willis is more prevalent in migraine with aura patients. This variation is linked to altered cerebral blood flow patterns, suggesting a potential role in migraine pathophysiology.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Biology

Background:

  • The circle of Willis is a critical arterial network at the base of the brain.
  • Variations in circle of Willis anatomy are common but their association with migraine is not fully understood.
  • Cerebral perfusion alterations may play a role in migraine pathogenesis.

Purpose of the Study:

  • To compare the prevalence of an incomplete circle of Willis in migraine with aura, migraine without aura, and control groups.
  • To investigate the correlation between circle of Willis variations and cerebral blood flow.
  • To assess if circle of Willis anatomy influences hemispheric perfusion asymmetry.

Main Methods:

  • Prospective enrollment of migraine with aura, migraine without aura, and control subjects in a 1:1:1 ratio.
  • Magnetic resonance angiography for circle of Willis anatomy assessment.
  • Arterial spin labeled perfusion MRI for cerebral blood flow measurement.
  • Standardized template for categorizing circle of Willis variants.

Main Results:

  • An incomplete circle of Willis was significantly more common in migraine with aura (73%) versus controls (51%).
  • A trend for higher prevalence was observed in migraine without aura (67%) versus controls.
  • Incomplete circle of Willis was associated with greater hemispheric cerebral blood flow asymmetry.

Conclusions:

  • An incomplete circle of Willis is more frequent in individuals with migraine with aura compared to controls.
  • Circle of Willis variations are associated with altered cerebral blood flow, particularly hemispheric asymmetry.
  • These findings suggest a potential link between circle of Willis anatomy and migraine pathophysiology.

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