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Infratentorial Microbleeds: Another Sign of Microangiopathy in Migraine
Enrico B Arkink1, Gisela M Terwindt2, Anton J M de Craen2
1From the Departments of Radiology (E.B.A., J.K., J.v.d.G., M.A.v.B., M.C.K.), Neurology (G.M.T., M.D.F.), and Gerontology and Geriatrics (A.J.M.d.C.), Leiden University Medical Center, Leiden, The Netherlands. e.b.arkink@lumc.nl.
Background And Purpose:
Migraine is a risk factor for clinical stroke and for subclinical white matter hyperintensities and infratentorial infarcts. These subclinical lesions are linked to small-vessel pathology. Cerebral microbleeds (CMBs) are another biomarker of small-vessel disease but have not yet been studied in migraine.
Methods:
Identification of CMBs in 63 migraineurs (25 with aura/35 without aura/3 unknown aura status) and 359 controls (aged, 73-85 years) from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) magnetic resonance imaging study. We assessed the modifying role of migraine in the co-occurrence of CMBs, infarcts, and white matter hyperintensity-load.
Results:
Infratentorial microbleeds were more prevalent in migraine without aura patients than controls (14% versus 4%). Prevalence of other CMBs, infarcts, and white matter hyperintensities did not differ between groups. Migraineurs with CMBs had more often infarcts than controls with CMBs (65% versus 43%). In comparison with controls with infarcts, migraineurs with infarcts had more commonly CMBs (55% versus 30%).
Conclusions:
Migraine, notably without aura, is associated with infratentorial CMBs at older age. CMBs and infarcts co-occur more often in migraine than in controls. This supports the hypothesis of small-vessel involvement in migraine pathophysiology.
Insights
Migraine, particularly without aura, is linked to infratentorial cerebral microbleeds (CMBs) in older adults. This finding suggests small-vessel disease may play a role in migraine pathophysiology.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Migraine is a known risk factor for clinical stroke and subclinical brain lesions.
- Subclinical lesions like white matter hyperintensities and infratentorial infarcts are associated with small-vessel pathology.
- Cerebral microbleeds (CMBs) are emerging biomarkers of small-vessel disease, but their presence in migraine patients has not been investigated.
Purpose of the Study:
- To investigate the prevalence of CMBs in older individuals with and without a history of migraine.
- To examine the association between migraine and the presence of CMBs, infarcts, and white matter hyperintensities.
- To explore the role of small-vessel disease in migraine pathophysiology.
Main Methods:
- A case-control study using magnetic resonance imaging data from 63 migraineurs and 359 controls (aged 73-85 years) from the PROSPER study.
- Identification and quantification of CMBs, infarcts, and white matter hyperintensities.
- Statistical analysis to assess the prevalence and co-occurrence of these markers in relation to migraine status.
Main Results:
- Infratentorial CMBs were significantly more prevalent in migraineurs without aura compared to controls (14% vs. 4%).
- No significant differences were observed in the overall prevalence of CMBs, infarcts, or white matter hyperintensities between migraineurs and controls.
- A higher co-occurrence of CMBs and infarcts was found in migraineurs compared to controls.
Conclusions:
- Migraine, especially without aura, is associated with infratentorial CMBs in an elderly population.
- The increased co-occurrence of CMBs and infarcts in migraine patients supports the hypothesis of small-vessel disease involvement in migraine.
- These findings highlight the potential link between migraine and cerebrovascular small-vessel pathology.
