Interictal cerebral and systemic endothelial dysfunction in patients with migraine: a case–control study

Abstract

BackgroundAlthough systemic endothelial function is unimpaired in migraine, it is unknown whether cerebral endothelial function impairment exists in migraineurs.Materials and methodsWe conducted a prospective study to assess endothelial function in migraineurs (n=45) and healthy volunteers (n=44). Cerebral endothelial function was assessed by Breath Holding Index (BHI) on transcranial Doppler in bilateral middle cerebral artery (MCA at 30–60 mm), posterior cerebral artery (PCA at 60–80 mm) and basilar artery (BA at 80–120 mm) using bilateral monitoring probes fixed on headband. Brachial artery flow-mediated dilation (FMD) was used as measure of systemic endothelial function.ResultsThere was no difference in baseline mean velocities of MCA, PCA, BA among migraineurs and controls. Mean BHI was significantly lower in PCA (p<0.001) and BA (p<0.001) in patients with migraine with no difference in MCA (p=0.909, 0.450). Cerebral endothelial dysfunction (BHI<1.15) was present in 62.2% of migraineurs in the right PCA (p<0.001), 57.8% in left PCA (p<0.001) and 77.8% in BA (BHI <0.83, p<0.001). There was no difference in BHI among migraineurs without and with aura (n=15). Cerebral and systemic endothelial function had no correlation in migraineurs. Increasing BMI was identified as a predictor of impaired BHI in the BA in migraineurs (p=0.020). Age, sex, presence of aura, lateralisation of headache, headache frequency, time to last attack and impaired FMD were not associated with impaired PCA and BA BHI in migraineurs.ConclusionsMigraineurs may have isolated cerebral endothelial dysfunction restricted to the posterior circulation in the absence of systemic endothelial dysfunction.

Migraine and Stroke: What’s the Link? What to Do?

“…Inflammatory cytokines released in the aura phase activate the endothelium leading to procoagulatory and prothrombotic state [55]. However, research of cerebrovascular reactivity in migraineurs has demonstrated conflicting data (decreased or increased cerebral vascular reactivity) in regard to the causal relationship of endothelium dysfunction in stroke pathogenesis [60–62]. …”

The Migraine–Stroke Connection

“…Systemic endothelial dysfunction has been widely tested in migraine with forearm blood flow by venous plethysmography, flow-mediated dilatation, and pulse-wave velocity analyses, yielding conflicting results [ 48 - 53 ]. In contrast, cerebral vascular reactivity has been consistently reported to be decreased in migraine, especially in the posterior circulation [ 51 , 52 ]. It seems that there is a lack of association between systemic and cerebral endothelial dysfunction in migraine [ 54 ].…”

De Novo Migraine With Aura After Surgical Repair of Aortic Coarctation

“…The pathophysiology of CoA involves more than simple mechanical obstruction of the aorta. There may exist more complexity such as impairment of systemic endothelial function, which may be associated with migraine pathophysiology . It is reported that abrupt hypotension precipitates migraine attacks with aura .…”