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Published on: June 2, 2014
Correlation between migraine and cerebral small vessel disease: A case-control study
Yanan Zhang1, Yanbo Li1,2, Li He1
1Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Background:
Microcirculatory pathology is one of the pathophysiological theories of migraine, which may present as visually subclinical lesions. Image markers of cerebral small vessel disease (CSVD) have been investigated in elderly migraineurs. However, past studies looked at only part of image features, and the conclusions may have been hindered by confounding factors. The relationship between migraine and CSVD signs needs reliable demonstrations.
Methods:
We conducted a case-control study by recruiting episodic young migraineurs from a tertiary headache centre, with tension-type headache (TTH) and healthy controls. Distinct image features of microvascular damage and baseline characteristics across groups were assessed, and multivariate linear regression was performed to evaluate the risk factors for image abnormalities in migraineurs.
Results:
Forty-eight migraineurs, 32 TTHs and 49 healthy controls were included. The median age was 32 year-old. 58.7% of the participants were female. The Scheltens score and volume of white matter hyperintensities (WMHs) in migraineurs, and the number of Virchow-Robin spaces (VRSs) in both migraineurs and TTHs were different from those in normal controls. No lacunar infarct-like lesions (ILLs) or cerebral microbleeds (CMBs) were found. Age, education level (high level: β = -2.23, lobar WMHs), attack duration (long duration: β = 3.81, lobar WMHs) and attack frequency were independent risk factors for Scheltens score and volume of WMH in migraineurs. Migraine aura (β = -2.389), attack frequency and education level were correlated with the number of VRSs.
Conclusions:
Migraine was associated with WMHs and VRSs. Aura, attack duration, attack frequency, age and education level were risk factors for image abnormalities of CVSD in migraineurs.
Significance:
This study provides a novel and comprehensive landscape of CSVD MRI features in young migraineurs, and it fills the blank of CMBs and VRSs which received less attention, with more persuasive, more reliable and stronger evidence of the association between CSVD and migraine. Our results also imply some new feature of TTH and the possible pathophysiology of the migraine course as well as new clues for the early management of migraine in terms of visual brain damage.
Insights
Young migraineurs show signs of cerebral small vessel disease (CSVD), specifically white matter hyperintensities (WMHs) and Virchow-Robin spaces (VRSs). Factors like aura, attack frequency, and duration are linked to these brain changes.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Neurology
Background:
- Microcirculatory pathology is a proposed mechanism in migraine pathophysiology.
- Cerebral small vessel disease (CSVD) markers have been studied in elderly migraineurs, but comprehensive analyses in younger populations are lacking.
- Previous studies on migraine and CSVD have been limited by focusing on specific imaging features and potential confounding factors.
Purpose of the Study:
- To investigate the association between migraine and various imaging markers of CSVD in young adults.
- To identify risk factors for CSVD-related image abnormalities in migraineurs.
- To provide a comprehensive MRI assessment of CSVD in young migraineurs, including less-studied features like cerebral microbleeds (CMBs) and Virchow-Robin spaces (VRSs).
Main Methods:
- A case-control study involving episodic young migraineurs, tension-type headache (TTH) patients, and healthy controls.
- Assessment of distinct microvascular damage imaging features and baseline characteristics.
- Multivariate linear regression analysis to determine risk factors for image abnormalities in migraineurs.
Main Results:
- The study included 48 migraineurs, 32 TTH patients, and 49 healthy controls (median age 32 years, 58.7% female).
- Migraineurs showed significant differences in Scheltens score and white matter hyperintensities (WMHs) volume compared to controls. Both migraineurs and TTH patients had different numbers of Virchow-Robin spaces (VRSs) compared to controls.
- No lacunar infarct-like lesions (ILLs) or cerebral microbleeds (CMBs) were detected. Age, education level, attack duration, and attack frequency were identified as independent risk factors for WMHs. Migraine aura, attack frequency, and education level correlated with VRSs.
Conclusions:
- Migraine is associated with white matter hyperintensities (WMHs) and Virchow-Robin spaces (VRSs).
- Risk factors for CSVD image abnormalities in migraineurs include aura, attack duration, attack frequency, age, and education level.
- The findings offer new insights into the pathophysiology of migraine and TTH, suggesting potential targets for early management of visual brain damage in migraine.
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