Risk factors of migraine-related brain white matter hyperintensities: an investigation of 186 patients

Abstract

Brain white matter hyperintensities are more prevalent in migraine patients than in the general population, but the pathogenesis and the risk factors of these hyperintensities are not fully elucidated. The authors analyzed the routine clinical data of 186 migraine patients who were referred to the Outpatient Headache Department of the Department of Neurology, Medical School, University of Pécs, Hungary between 2007 and 2009: 58 patients with white matter hyperintensities and 128 patients without white matter hyperintensities on 3 T MRI. Significant associations between the presence of white matter hyperintensities and longer disease duration (14.4 vs. 19.9 years, p = 0.004), higher headache frequency (4.1 vs. 5.5 attacks/month, p = 0.017), hyperhomocysteinemia (incidence of hyperintensity is 9/9 = 100%, p = 0.009) and thyroid gland dysfunction (incidence of hyperintensity is 8/14 = 57.1%, p = 0.038) were found. These data support the theory that both the disease duration and the attack frequency have a key role in the formation of migraine-related brain white matter hyperintensities, but the effects of comorbid diseases may also contribute to the development of the hyperintensities.

Migraine and structural changes in the brain

“…High incidence of WMAs is found in migraineurs with subclinical hyperthyroidism and hypothyroidism and elevated levels of homocysteine. 34 The prevalence of patent foramen ovale 35 and mitral valve prolapse 36 may also contribute to the WMAs. In some cases, the number, distribution, and location of WMAs may lead to the diagnosis of an underlying disease of which migraine may be a secondary cause, such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, 37 mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes, 38 or multiple sclerosis.…”

Structural and Functional Neuroimaging in Migraine: Insights From 3 Decades of Research

“…69 Hyperintensities in the white matter. 61,65,[70][71][72]77 Increased iron deposition in the periaqueductal grey, putamen, globus pallidus, and red nucleus. 70,[78][79][80]83 Increased stroke risk, especially in the posterior circulation.…”

“…68 Voxel-based morphometry Decreased grey matter density in the frontal, parietal, and temporal lobes; 82 increased in the periaqueductal grey. 71,72 Decreased grey matter density in chronic vs episodic migraine: bilaterally in the anterior cingulate cortex, left amygdala, left parietal operculum, left middle and inferior frontal gyri, right inferior frontal gyrus, and insula. 83 Decreased grey matter volume in the insula, motor/premotor cortex, prefrontal cortex, cingulate cortex, posterior parietal cortex, and orbitofrontal cortex.…”

“…65,70 Retrospective analyses of clinical data pertaining to 186 patients with migraine yielded significant associations between the presence of white matter hyperintensities and longer disease duration and higher headache frequency. 71 A population-based, crosssectional study (Epidemiology of Vascular Ageing Study, France) found that any history of severe headache associates with increased volume of white matter hyperintensities. 72 Migraine with aura was the only headache type associated with brain infarcts.…”

White Matter Lesions in a Patient with Headache – Case Report and Review of the Literature

“…While brain WMH are more prevalent in migraine patients than in the general population, the pathogenesis and the risk factors of these hyperintensities are not fully elucidated (Trauninger et al, 2011). Lesions can be non-specific and clinically insignificant in many cases, but sometimes the reason for their presence is an underlying disease.…”