Migraine as a Risk Factor for Subclinical Brain Lesions

Abstract

IGRAINE IS A COMMON, chronic, multifactorial neurovascular disorder typically characterized by recurrent attacks of disabling headache and autonomic nervous system dysfunction (migraine without aura); up to one third of patients also have neurological aura symptoms (migraine with aura). 1,2 Migraine has been suggested to be an independent risk factor for stroke, but the evidence is conflicting and seems to be restricted to certain subpopulations (eg, women with migraine with aura who are younger than 45 years, particularly ones who smoke or use oral contraceptives [OCs]). 3-9 Case reports on patients with so-called migrainous infarction suggest that the posterior circulation territory (PCT) is most commonly affected. 8,9 However, data are lacking on prevalence of subclinical infarcts in a wide spectrum of migraine patients in the general population. Patients with migraine may also be at increased risk of more diffuse subclinical lesions in the deep white matter or periventricular areas that are only detected on neuroimaging. 10-12 Several clinic-based magnetic resonance imaging (MRI) studies have reported this,

Comorbid neuropathologies in migraine

“…4) [35]. A Dutch study [36], however, did not show any significant difference in infarct prevalence between migraineurs and nonmigraineurs, although cerebellar lesions were more common in patients with migraine, particularly in those with aura and with frequent attacks, than in people who did not have migraine. Among …”

Preventing chronicity of migraine

“…Frequently recurring migraine episodes may predispose a person to disease chronicity through a permanent status of central sensitisation. Neuroimaging studies showed that brain white matter lesions increased with episode frequency, possibly demonstrating progression of the disease [6]. In addition, repetitive attacks may lead to chronic headache through a progressive impairment of the central antinociceptive system in the periaqueductal grey matter that controls activity of the trigeminovascular system [7].…”

Transcranial Doppler measurements in migraine and nitroglycerin headache

“…It is pos-V V sible that vasoconstriction of the posterior circulation is the reason for some of the symptoms of the migraine aura, attack or the postdromal phase. For example, frequent migraine history has been reported in cases of VA V V dissections [25]; even strokes and white matter lesions in the posterior circulation distribution were found to be more common in people with migraine [26].…”