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Microstructural white matter changes preceding white matter hyperintensities in migraine

Enrico B Arkink1, Inge H Palm-Meinders1, Hille Koppen1

  • 1From the Departments of Radiology (E.B.A., I.H.P.-M., J.M., B.v.L., M.A.v.B., M.C.K.) and Neurology (H.K.) and Laboratory for Clinical and Experimental Image Processing, Department of Radiology (J.M., B.v.L.), Leiden University Medical Center; Department of Neurology (H.K., G.M.T., M.D.F.), Haga Hospital, The Hague, the Netherlands; Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD; and Department of Radiology (P.A.M.H.), Maastricht University Medical Center, the Netherlands.

Neurology
|July 13, 2019
PubMed
Abstract

Insights

Migraine patients show subtle white matter changes before visible lesions appear. These invisible microstructural alterations in normal-appearing white matter may precede the development of white matter hyperintensities in migraine.

Area of Science:

  • Neuroimaging
  • Neurology
  • White Matter Integrity

Background:

  • Migraine is associated with white matter hyperintensities (WMHs).
  • The microstructural integrity of white matter in migraineurs, particularly in areas without visible lesions, remains incompletely understood.
  • It is unclear whether diffuse or focal microstructural changes precede the development of WMHs.

Purpose of the Study:

  • To assess white matter tissue integrity in migraine using magnetization transfer imaging.
  • To determine if white matter microstructure is diffusely affected beyond visible WMHs.
  • To investigate if focal invisible microstructural changes precede visible focal WMHs in migraineurs.

Main Methods:

  • Longitudinal study (9-year follow-up) of 137 migraineurs and 74 controls from the CAMERA study.
  • Magnetization transfer ratio (MTR) calculated for whole brain white matter at baseline.
  • Baseline MTR values of normal-appearing white matter (NAWM) that later developed WMHs were compared to contralateral NAWM.

Main Results:

  • No significant difference in whole brain white matter MTR between migraineurs and controls.
  • In migraineurs, NAWM that progressed to WMHs at follow-up showed lower baseline MTR compared to contralateral white matter (p=0.047).
  • No such difference was observed in controls.

Conclusions:

  • No evidence of widespread microstructural white matter changes in migraineurs compared to controls.
  • Findings suggest a gradual process where invisible microstructural changes may precede visible WMHs in migraine.
  • This indicates a potential stepwise evolution of focal white matter pathology in migraine.

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