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White matter lesions in chronic migraine with medication overuse headache: a cross-sectional MRI study
Zhenyang Zheng1, Zijian Xiao, Xiaolei Shi
1Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
Abstract:
Analgesic overuse often happens to migraine patients, especially chronic migraineurs, and migraine has been demonstrated to be associated with white matter lesions (WMLs). The aim of this study was to investigate the relationship between medication overuse headache (MOH) and WMLs in chronic migraine (CM) patients. Subjects were enrolled and divided into three groups: healthy controls, CM without MOH (CMwoMOH), and CM with MOH (CM-MOH). Most of the CM patients used non-steroidal anti-inflammatory drugs (NSAIDs) as acute headache medications. All the participants underwent magnetic resonance imaging scans and images were obtained for WML evaluation with semiquantitative scales. One hundred and forty-one participants were included, 45 of them for controls, 38 for CMwoMOH, and 58 for CM-MOH. In women, CMwoMOH patients had a higher prevalence of high WML load compared with controls and CM-MOH patients. In men, however, all the study groups showed no differences in the prevalence of high WML load. CMwoMOH women had increased risks of high deep white matter lesion (DWML) load compared with controls, while they had no risks of high periventricular white matter lesion (PVWML) load. CM-MOH women had no risks of high DWML load, but they had reduced risks of high PVWML load. The association of CM-MOH with high WML load in women was not changed when compared with CMwoMOH. Age was independently associated with high WML load among women. These data suggest that MOH caused by NSAIDs is not a risk factor for WMLs. Rather, NSAID overuse probably protects MOH patients from WMLs through anti-inflammatory effects.
Insights
Medication overuse headache (MOH) in chronic migraine patients, particularly women using NSAIDs, may paradoxically protect against white matter lesions (WMLs). This suggests NSAID overuse might have a protective role, not a detrimental one, regarding WMLs.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Chronic migraine (CM) is frequently linked to white matter lesions (WMLs).
- Analgesic overuse, leading to medication overuse headache (MOH), is common in migraineurs.
- The relationship between MOH and WMLs in CM patients requires further investigation.
Purpose of the Study:
- To explore the association between medication overuse headache (MOH) and white matter lesions (WMLs) in chronic migraine (CM) patients.
- To differentiate WML prevalence in CM patients with and without MOH, considering medication usage patterns.
Main Methods:
- Magnetic resonance imaging (MRI) scans were utilized for WML evaluation using semiquantitative scales.
- Participants were categorized into three groups: healthy controls, CM without MOH (CMwoMOH), and CM with MOH (CM-MOH).
- Analysis focused on WML load, including deep white matter lesions (DWML) and periventricular white matter lesions (PVWML), stratified by sex.
Main Results:
- In women, CMwoMOH patients exhibited a higher prevalence of high WML load compared to controls and CM-MOH patients.
- CMwoMOH women showed increased risks of high DWML load but not PVWML load compared to controls.
- CM-MOH women had no increased risk of high DWML load and a reduced risk of high PVWML load; age was independently associated with WML load in women.
Conclusions:
- Medication overuse headache (MOH) induced by NSAIDs does not appear to be a risk factor for WMLs in chronic migraine patients.
- NSAID overuse may confer a protective effect against WMLs, potentially due to anti-inflammatory mechanisms.
- Findings highlight a complex, potentially protective relationship between NSAID overuse and WMLs in specific chronic migraine populations.
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