No association between migraine frequency, white matter lesions and silent brain infarctions: a study in a series of women with chronic migraine

Abstract

Background and purpose It has been suggested that silent infarctions (SIs) and hyperintense white matter lesions (WMLs) are related to migraine frequency. We studied their prevalence and anatomical distribution in patients with chronic migraine (CM). Methods A total of 96 women with CM [mean age 43 (range 16–65) years] and 29 women with episodic migraine (EM) [mean age 36 (range 16–58) years] underwent 1.5‐T magnetic resonance imaging following the CAMERA protocol. The number, size and location of SIs and deep WMLs were recorded and a modified Fazekas scale was applied to assess periventricular WMLs. Results White matter lesions were found in 59 (61.5%) women with CM and 17 (58.6%) women with EM (odds ratio, 1.13; 95% confidence intervals, 0.48–2.62; P = 0.784). The majority (63% CM and 71% EM) were small deep WMLs. Exclusive periventricular WMLs were exceptional. Of the 739 WMLs seen in patients with CM, 734 (99.3%) were hemispheric and mostly frontal (81%). Posterior fossa WMLs were seen in only five (5.2%) women with CM (always in the pons) and two (6.9%) women with EM. Age >45 years was the only vascular risk factor associated with a higher WML number (median: 0 < 45 years and 3 > 45 years; P = 0.004). We found seven SIs in six women with CM (6.3%). Conclusions As compared with the expected prevalence at this age, this study confirms that the prevalence of WMLs, in most cases small, deep and frontal, was increased in CM and EM. However, our results do not support an association of WMLs or SIs with a higher frequency of attacks, but with the presence of vascular risk factors and mainly age >45 years.

White Matter Hyperintensity in Different Migraine Subtypes

“…This may be explained by a presence of a common link of WMH pathogenesis, maybe associated with vasodilation and plasma extravasation. In our study, we did not nd any relationship between severity of WMH and the severity of migraine as it was demonstrated in previous studies 4,11,13,14,18,19,[24][25][26] . The exclusion of vascular risk factors allowed us to suggest that there were no other causes leading to the increased permeability of the blood-brain barrier other than migraine; therefore, it can be assumed that the underlying mechanisms of WMH pathogenesis include individual properties of the endothelium associated with high vascular wall permeability.…”

“…The in uence of age and vascular factors on the disseminated distribution of WMH in migraine was also con rmed in a recent study by Meilan A. et al (2020). Among the investigated factors, only the age > 45 years was associated with the severity of WMH, while the type of migraine and the frequency of attacks did not 26 .…”

“…Universal differentiating features for all types of migraine were: predominance of WMH within the frontal lobe and a lower incidence of lesions within the parietal and temporal lobes and their absence within other lobes; equal incidence of juxtacortical and deep location along with less frequent periventricular localization; small (2.5 [1.5; 3] mm) lesion size; the absence of a tendency to merge. Previous studies have reported not only the localization of WMH within frontal, parietal and temporal lobes 9,13,12,18,26,[30][31][32] , but also their infratentorial and occipital location 11,18,30,34 , the involvement of periventricular white matter 6,8,10,13,26 , various sizes of WMH, including con uent lesions 31 .…”

“…Several studies demonstrated the association between the WMH burden and the frequency of pain attacks 13,14,18 , duration of disorder 11,19 , its progression over time 6,16,20 , the risk of ischaemic stroke 21,22 and CI 23 , while other studies did not establish any relationship between WMH and severity or duration of migraine 4,[24][25][26] , risk of stroke and other vascular events 11,24 , CI 9,16,27,28 , and progression of WMH over time 29 . WMH in patients with different types of migraine are predominantly located within the frontal and parietal lobes 9,12,13,18,26,[30][31][32] , in deep and periventricular 6,8,10,13,26 , and sometimes juxtacortical white matter 20,31,32 , with sizes varying from small single to con uent larger lesions 20,[30][31][32] . WMH may be found along with asymptomatic small cerebral infarctions, mainly in the vertebrobasilar system 5,13,18,…”

White matter hyperintensity in different migraine subtypes

“…Several studies demonstrated the association between the WMH burden and the frequency of pain attacks 13 , 14 , 18 , duration of disorder 11 , 19 , its progression over time 6 , 16 , 20 , the risk of ischemic stroke 21 , 22 and CI 23 , while other studies did not establish any relationship between WMH and severity or duration of migraine 4 , 24 – 26 , risk of stroke and other vascular events 11 , 24 , CI 9 , 16 , 27 , 28 , and progression of WMH over time 29 . WMH in patients with different types of migraine are predominantly located within the frontal and parietal lobes 9 , 12 , 13 , 18 , 26 , 30 – 32 , in deep and periventricular 6 , 8 , 10 , 13 , 26 , and sometimes juxtacortical white matter 20 , 31 , 32 , with sizes varying from small single to confluent larger lesions 20 , 30 – 32 . WMH may be found along with asymptomatic small cerebral infarctions, mainly in the vertebrobasilar system 5 , 13 , 18 , 33 , 34 and cerebral microbleedings 35 .…”