Vertebrobasilar artery elongation in migraine—a retrospective cross-sectional study

Abstract

Background Numerous but inconclusive findings have sparked an ongoing debate about whether the arteries of migraine patients undergo vascular alterations. The outlet angle of the superior cerebellar artery (SUCA) and the lateral displacement of basilar arteries are good surrogate parameters for determining elongation of the vertebrobasilar arteries. Methods We retrospectively determined the SUCA outlet angle and the lateral displacement of the basilar artery in 63 patients with migraine (30.6 ± 8.9 years, 84% women, 16% chronic migraine, 60% migraine with aura) and compared these with 126 age- and sex-matched control subjects. Results In patients with migraine, the SUCA outlet angle was lower (159 ± 26° vs. 169 ± 29°, p = 0.020) and the lateral displacement of the basilar artery was greater (3.7 ± 2.7 mm vs. 2.8 ± 2.4 mm, p = 0.020) than in the control subjects. Age, gender, migraine characteristics and presence of any cardiovascular risk factors did not affect the SUCA outlet angle or lateral displacement of the basilar artery. Conclusion Migraine patients exhibited a lower SUCA outlet angle and greater lateral displacement of the basilar arteries. Both may be attributable to the elongation of the vertebrobasilar arteries, which is an indication of arterial wall pathology in migraine.

Association between vertebral artery dominance and basilar artery curvature in migraineurs: an anatomical magnetic resonance imaging study

“…69 A longitudinal study by Ngo et al revealed that the bending length of BA after approximately 10 years was more pronounced in patients with VAD than in non-VAD patients. 70 In the present study, we observed that the total lateral displacement of BA increases with aging within the migraine group, which is similar to the result of Hensel et al 29 In addition, we found that the height of BA bifurcation increases with aging in both groups, which is similar to the findings of previous studies. 70,71 Nevertheless, it was observed that despite the control group having a higher average age compared to the migraine group, the height of the BA bifurcation was found to be significantly higher in migraineurs.…”

“…23 Several studies have revealed that patients with migraine, particularly MwA patients without a VAD, exhibit a higher degree of lateral displacement of the BA compared to control subjects. [27][28][29] An MR angiography study conducted by Hensel et al found that lateral displacement of the BA in patients with migraine was higher than that in control subjects, and the frequency of the displacement showed a peak shift to the right. Researchers postulate that lateral displacement could be due to contralateral hypoplasia of the VA. 29 Our study also found the same results as those of Hensel et al, but our results were not statistically significant.…”

“…[27][28][29] An MR angiography study conducted by Hensel et al found that lateral displacement of the BA in patients with migraine was higher than that in control subjects, and the frequency of the displacement showed a peak shift to the right. Researchers postulate that lateral displacement could be due to contralateral hypoplasia of the VA. 29 Our study also found the same results as those of Hensel et al, but our results were not statistically significant. On the other hand, we found that among MwA patients with left-side VAD, the rate of BA displacement toward the right side was significantly higher than that in patients with rightside VAD or non-VAD.…”

“…Hensel et al revealed narrowing of the superior cerebellar artery outlet angle in migraine patients, which is interpreted as an indication of elongation in the BA as well as VAs and their branches. 29 It has been demonstrated that decreased superior cerebellar artery outlet angle correlates with the Smoker’s score. 72 However, due to the Smoker’s score can be easily applied to conventional T2 sagittal MR images and is less time-consuming, it is used more frequently in the clinic.…”

“…26 Recent studies have shown that the lateral displacement of the BA tends to be greater in patients with MwA compared to control subjects. [27][28][29] Furthermore, Hensel et al have reported that migraine patients also have a narrower superior cerebellar artery outlet angle, which may be attributed to the elongation of the VBS arteries together with the lateral displacement of the BA. 29 Although the causes of the lateral displacement or elongation of the BA have not been conclusively established by researchers, they have proposed that the lateral displacement of the BA may be due to contralateral hypoplasia of the VA. Several studies have shown that unequal mechanical forces due to VA hypoplasia may influence the hemodynamics of the VBS, ultimately leading to the elongation and lateral displacement of the BA toward the nondominant VA side.…”