Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: The population-based MRI CAMERA study

Abstract

Background Previous studies suggested that migraine is a risk factor for brain lesions, but methodological issues hampered drawing definite conclusions. Therefore, we initiated the MRI “CAMERA” study. Procedures We summarize our previously published results. A total of 295 migraineurs and 140 controls were randomly selected from a previously diagnosed population-based sample (n=6039), who underwent an interview, physical examination, and a brain MRI-scan. Findings Migraineurs, notably those with aura, had higher prevalence of subclinical infarcts in the posterior circulation (OR=13.7; 95%CI 1.7–112). Female migraineurs were at independent increased risk of white matter lesions (WML; OR=2.1; 95%CI 1.0–4.1), and migraineurs had a higher prevalence of brainstem hyperintense lesions (4.4% vs. 0.7%, p=0.04). We observed a higher lifetime prevalence of (frequent) syncope and orthostatic insufficiency in migraineurs; future research needs to clarify whether autonomic nervous system dysfunction could explain (part of) the increased risk of WMLs in female migraineurs. Finally, in migraineurs aged <50, compared to controls, we found evidence of increased iron concentration in putamen (p=0.02), globus pallidus (p=0.03) and red nucleus (p=0.03). Higher risks in those with higher attack frequency or longer disease duration were found consistent with a causal relationship between migraine and lesions. Conclusion This summary of our population-based data illustrates that migraine is associated with a significantly increased risk of brain lesions. Longitudinal studies are needed to assess whether these lesions are progressive and have relevant (long-term) functional correlates.

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

“…It is generally accepted that the common forms of migraine with or without aura (Table 2): abnormal thickness, connectivity and/or activation of certain cortical and subcortical areas [24][25][26][27], increased transmitter [28] or iron content [29][30][31], decreased ATP content [32,33] and an abnormal pattern of sensory processing [34,35]. The latter is characterized by low amplitude of initial responses and hyperresponsivity with lack of habituation of late responses during repeated sensory stimuli [36], and has been attributed to a thalamocortical dysrhythmia caused by deficient monoaminergic control by brain stem nuclei (review in [37]).…”

“…cortical sensitivity and % responsivity to sensory stimuli [35,36] % fractional anisotropy thalamus (MR-DTI) [43] ! cortical thickness and activation S1, temporal lobe [26] % cortical thickness and/or activation insula, cingulate, visual areas [24,26] % rs connectivity amygdala-insula [27] % iron content PAG and globus pallidus [29][30][31] % rs connectivity PAG-precuneus, visual [25] % tissue density in PAG [129] ! olfaction-induced trigeminal nucleus activation % pre-ictally [130] % subclinical posterior circulation infarcts [30] Chronic migraine % cortical sensitivity and !…”

“…In several studies, it has been shown that metabolic and morphological brain changes in EM increase with attack frequency [26,29,30]. Moreover, central sensitization that may occur during any migraine attack becomes persistent in CM and is thus likely to be a major chronifying factor, as suggested by a study of cutaneous allodynia [53].…”

Migraine-Associated Cerebrovascular Disorders

“…С этого времени накопилось достаточное количество дан-ных эпидемиологических исследований, демонстрирую-щих связь мигрени прежде всего с аурой, с риском ИИ. Более того, исследования нейровизуализации показывают более высокую частоту субклинических инфарктов мозга у пациентов с мигренью, которые чаще выявляются в заднем бассейне кровообращения, а у женщин, страдающих мигренью, частота выявления поражения белого вещества существенно выше, чем у женщин без головной боли [7,8].…”

“…Его распространенность в популяции достигает 1,4-3,4/100 000, что, по данным больших реги-стров инсультов, составляет 0,2-0,5% всех случаев ИИ [8]. В соответствии с международной классификацией голов-ных болей (ICHD-3) мигренозный инфаркт определяется как приступ мигрени с аурой, при котором один или более симптомов ауры длится дольше 60 мин и нейрови-зуализация демонстрирует ишемическое повреждение мозга в соответствующей зоне [13].…”