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CADASIL: Migraine, Encephalopathy, Stroke and Their Inter-Relationships
Rhea Yan Ying Tan1, Hugh Stephen Markus1
1Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
Plos One
|June 17, 2016
Summary
Migraine with aura is common in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) and linked to encephalopathy. Migraineurs in CADASIL showed reduced stroke risk, with triptan treatments proving safe.
Area of Science:
- Neurology
- Genetics
- Vascular Medicine
Background:
- Migraine is a frequent symptom in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), but treatment outcomes and stroke risk associations are not well-documented.
- Encephalopathy, a less common CADASIL presentation, may be linked to migraine, necessitating further investigation into their relationship.
Purpose of the Study:
- To characterize migraine patterns and treatment responses in CADASIL patients.
- To examine the association between migraine and stroke risk in CADASIL.
- To investigate the link between migraine and encephalopathy in CADASIL.
Main Methods:
- Prospective recruitment of 300 symptomatic CADASIL patients over 19 years (1996-2015).
- Standardized questionnaire for data collection, including migraine classification per the International Classification of Headache Disorders (ICHD-3 beta).
- Cross-sectional analysis of collected data.
Main Results:
- Migraine was present in 75.3% of patients, often with aura (89.8%).
- Triptan treatment showed partial or consistent response in 45.5% of patients, with no observed complications.
- Migraine with aura increased odds of encephalopathy (OR=5.4), particularly confusional aura (OR=2.5). Migraineurs exhibited reduced stroke risk (HR=0.46).
Conclusions:
- Migraine with aura is a significant feature of CADASIL, with treatment responses comparable to the general population and triptans demonstrating safety.
- The association between migraine with aura and encephalopathy suggests shared pathophysiological mechanisms.
- Migraine in CADASIL appears to be associated with reduced, not increased, stroke risk, though further confirmation is required.
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