Migraine and white matter hyperintensities

Abstract

Objective: Migraine is associated with white matter hyperintensities (WMH) cross-sectionally, but its effect on WMH progression is uncertain.Methods: Participants in the Atherosclerosis Risk in Communities cohort study (n 5 10,924) completed a standardized headache questionnaire between 1993 and 1995. A subset of participants (n 5 1,028) received 2 MRIs 8 to 12 years apart: once at the time of headache ascertainment, and again from 2004 to 2006. WMH were quantified using both a visually graded score (0-9) and semiautomated volumetric analysis. Linear and logistic regression models adjusted for age, sex, and other vascular risk factors were constructed.Results: Individuals who had migraine without aura were cross-sectionally associated with an 87% greater odds of having a WMH score $3 than individuals without headache (adjusted odds ratio 5 1.87; 95% confidence interval [CI]: 1.04, 3.37). Participants with migraine had an average of 2.65 cm 3 more WMH than those without headache (95% CI: 0.06, 5.24). However, there was no significant difference in WMH progression over the study period between individuals with and without migraine (1.58 cm 3 more progression for individuals with migraine compared to those without; 95% CI: 20.37, 3.53). Conclusion:Migraine is associated with WMH volume cross-sectionally but not with WMH progression over time. This suggests that the association between migraine and WMH is stable in older age and may be primarily attributable to changes occurring earlier in life, although further work is needed to confirm these findings. Several epidemiologic studies, including 2 recent population-based studies, 1,2 have demonstrated a cross-sectional association between migraine and white matter hyperintensities (WMH), a common MRI finding that is believed to represent chronic small-vessel cerebrovascular disease.3 However, these studies differ regarding the effect of sex and the presence of aura on the association between migraine and WMH. A follow-up of one of these studies found that migraine was associated with greater WMH progression, but that this was specific to women with supratentorial deep WMH. 4 To further investigate the relationship between migraine and white matter disease, we analyzed data from the Atherosclerosis Risk in Communities (ARIC) brain MRI study. We hypothesized that a history of migraine would be associated with both baseline WMH volume and WMH progression over time.METHODS Study design and participants. The ARIC study is an ongoing prospective cohort study designed to investigate the etiology of atherosclerosis and the variation in cardiovascular disease and risk factors by race and socioeconomic status.

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

“…51,52 WMHs are likely more common in individuals with stroke, dementia, migraine, 53,54 or late-life depression 55 but not in younger adults with bipolar disease or schizophrenia. 56 In community-based samples, WMH prevalence was low before 55 years of age 57 but increased sharply with age thereafter, from 11% to 21% in the subjects 64 years of age on average to 94% in individuals 82 years of age on average.…”

Adiponectin and leptin levels in migraineurs in the Atherosclerosis Risk in Communities Study

“…At visit 3, trained interviewers administered a headache questionnaire to all participants. 23,24 Participants were queried as to whether they ever experienced headaches lasting 4 or more hours. Those reporting never experiencing headaches lasting $4 hours were categorized as nonmigraine controls, herein referred to as controls.…”

Appropriate Use of Neuroimaging in Headache

“…After looking at data between 10 years, they found that migraine patients without aura had an 87 % greater chance of having a greater WMH score than those without headache cross-sectionally [38]. They did, however, show that these WMH progressed over time.…”