ABSTRACT
Aim:
Cerebral white matter hyperintensities (WMLs) are known to be observed in migraine patients but there only are a handful of studies focused on WMLs in migraine with aura (MWA). In this study, we aimed to investigate the frequency of WML and demographic and environmental factors associated with WML in patients with MWA.
Methods:
A total of 112 patients diagnosed with migraine were enrolled. Detailed systemic and neurological examinations, blood pressure, weight and height measurements, presence of hypertension, smoking status, clinical and demographical data and visual analog scale, allodynia symptom checklist (ASC) and migraine disability assessment scale scores were recorded. The migraine groups with and without aura were compared statistically. A logistic regression analysis was performed to analyse the risk factors for the development of WMLs.
Results:
Supratentorial and periventricular WMLs were more frequent in patients with MWA (p=0.008). Presence of aura and longer disease duration were independent risk factors for the development of WMLs (p=0.0020 and p=0.019, respectively). Migraine attack frequency, and ASC scores were higher in patients with MWA (p=0.005, p=0.015 and p<0.001, respectively).
Conclusion:
Our results show a significant increase in non-specific WMLs in patients with MWA. A longer disease duration and presence of aura are significant risk factors for development of these lesions. Our findings warrant further research to validate our result.
References
1Launer LJ, Terwindt GM, Ferrari MD. The prevalence and characteristics of migraine in a population based cohort: the GEM study. Neurology 1999;53:537-42.
2Alemdar M, Selekler M. Migren ve kortikal yayılan depresyon. Ağrı 2006; 18: 24-30.
3Ertas M, Baykan B, Orhan EK et al. One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nationwide home-based study in adults. J Headache Pain 2012;13:147-57.
4Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol 2017;16:76-87.
5Uggetti C, Squarza S, Longaretti F, et al. Migraine with aura and white matter lesions: an MRI study. Neurol Sci 2017;38:11-13.
6Kruit MC, van Buchem MA, Hofman PA, et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004;291:427-34.
7Colombo B, Dalla Libera D and Comi G. Brain White matter lesions in migraine: what’s the meaning? Neurol Sci 2011;32:S37-40.
8Kamson DO, Illés Z, Aradi M, et al. Volumetric comparisons of supratentorial white matter hyperintensities on FLAIR MRI in patients with migraine and multiple sclerosis. J Clin Neurosci 2012;19:696-701.
9Scher AI, Gudmundsson LS, Sigurdsson S, et al. Migraine headache in middle age and late-life brain infarcts: the age gene/ environment susceptibility—Reykjavik Study. JAMA 2009;301:2563-70.
10Olesen J, for the Third International Headache Classification Committee of the International Headache Society: New plans for headache classification: ICHD-3. Editorial. Cephalalgia 2011;31:4-5.
11Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing and Health 1990;13:227-36.
12Hawker GA, Mian S, Kendzerska T, French M. Measures of Adult Pain Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res 2011;63: 240-52.
13Lipton RB, Bigal ME, Ashina S, et al. Cutaneous allodynia in the migraine population. Ann Neurol 2008; 63:148-58.
14Yalın OÖ, Uludüz D, Sungur MA, Sart H, Özge A. Identification of allodynic migraine patients with the turkish version of the allodynia symptom checklist: Reliability and consistency study. Noro Psikiyatr Ars 2017;54:260-66.
15Ekizoglu E, Baykan B, Orhan EK, Ertas M. The analysis of allodynia in patients with idiopathic intracranial hypertension. Cephalalgia 2012;32:1049-58.
16Stewart WF, Lipton RB, Kolodner K, Liberman J, Sawyer J. Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalalgia 1999;19:107-14.
17Aradi M, Schwarcz A, Perlaki G, et al. Quantitative MRI studies of chronic brain White matter hyperintensities in migraine patients. Headache 2013;53:752-63.
18Palm-Meinders IH, Koppen H, Terwindt GM, et al. Structural brain changes in migraine. JAMA 2012; 308:1889-97.
19Zhang Q, Datta R, Detre JA, Cucchiara B. White matter lesion burden in migraine with aura may be associated with reduced cerebral blood flow. Cephalalgia 2017; 37:517-24.
20Kurth T, Mohamed S, Maillard P, et al. Headache, migraine, and structural brain lesions and function: population based Epidemiology of Vascular Ageing-MRI study. BMJ 2011;342:c7357.
21Kruit MC, Launer LJ, Ferrari MD, Van Buchem MA. Brain stem and cerebellar hyperintense lesions in migraine. Stroke 2006;37: 1109-12.
22Crassard I, Conard J, Bousser MG. Migraine and haemostasis. Cephalalgia 2001;21:630-36.
23Tietjen GE, Al Qasmi MM, Athanas K, Dafer RM, Khuder SA. Increased von Willebrand factor in migraine. Neurology 2001;57:334-36.
24Tzourio C, El Amrani M, Poirier O, Nicaud V, Bousser MG, Alperovitch A. Association between migraine and endothelin type A receptor (ETA -231 A/G) gene polymorphism. Neurology 2001;56:1273-77.
25Dreier JP, Kleeberg J, Petzold G, et al. Endothelin-1 potently induces Leao’s cortical spreading depression in vivo in the rat: a model for an endothelial trigger of migrainous aura? Brain 2002;125:102-12.
26Goadsby PJ. Pathophysiology of migraine: a disease of the brain. In: Goadsby PJ, Silberstein SD, eds. Headache. Boston: Butterworth-Heinemann 1997:5-25.
27Smith M, Cros D, Sheen V. Hyperperfusion with vasogenic leakage by fMRI in migraine with prolonged aura. Neurology 2002;58:1308-10.
28Gentile S, Rainero I, Daniele D, Binello E, Valfrè W, Pinessi L. Reversible MRI abnormalities in a patient with recurrent status migrainosus. Cephalalgia 2009;29:687-90.
29Mar S, Kelly JE, Isbell S, Aung WY, Lenox J, Prensky A. Prevalence of white matter lesions and stroke in children with migraine Neurology 2013; 81:1387-91.
30Galli A, Di Fiore P, D’Arrigo G, et al. Migraine with aura white matter lesions: preliminary data on clinical aspects. Neurol Sci 2017;38:7-10.
31Kruit MC, Van Buchem MA, Launer LJ, et al. 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. Cephalalgia 2010;30:129-36.
32Mathew NT, Kurman R, Perez F. Drug induced refractory headache - clinical features and management. Headache 1990;30:634-38.
33Kudrow L. Paradoxical effects of frequent analgesic use. Adv Neurol 1982;33:335-41.
34Katsarava, Z, Schneeweiss S, Kurth T, et al. Incidence and predictors for chronicity of headache in patients with episodic migraine. Neurology 2004; 62:788-90.
35Bahra A, Walsh M, Menon S, Goadsby PJ. Does chronic daily headache arise de novo in association with regular use of analgesics? Headache 2003;43:179-90.
36Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 2003;106:81-9.
37Ashkenazi A, Sholtzow M, Shaw JW, et al. Identifying cutaneous allodynia in chronic migraine using a practical clinical method. Cephalalgia 2007;27:111-17.
38Guven H, Cilliler AE, Comoglu SS. Cutaneous allodynia in patients with episodic migraine. Neurol Sci. 2013;34:1397-1402.
39Baykan B, Ekizoglu E, Karli N, et al. Characterization of Migraineurs Having Allodynia: Results of a Large Population-based Study. Clin J Pain 2016 ;32 :631-35.
40Swartz RH, Kern RZ. Migraine is associated with magnetic resonance imaging white matter abnormalities: a meta-analysis. Arch Neurol 2004;61:1366-68.
41Etminan M, Takkouche B, Isorna FC, Samii A. Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. BMJ 2005;330:63.
42Erdélyi-Bótor S, Aradi M, Kamson DO, et al. Changes of migraine-related white matter hyperintensities after 3 years: a longitudinal MRI study. Headache 2015;55:55-70.
43Rist PM, Kurth T. Migraine and cognitive decline: a topical review. Headache 2013;53:589-98.
