Neuro-structural Evaluation by Magnetic Resonance Imaging in Patients Diagnosed with Migraine Headaches, with and without Aura

Abstract

Introduction: Migraine is one of the most common disabling disorders affecting more than 20% of general population at least for once in their lifetime. There are generally two types of migraine headaches, classified as with and without auras, presenting as visual, sensory or motor symptoms. In this study, authors plan to investigate the structural difference between these patients group by Magnetic Resonance Imaging (MRI) in a prospective casecontrol study. Materials and Methods: From August 2015 to October 2017, we have enrolled 40 patients suffering from migraine with aura symptoms into group A, and also we have categorized another 40 patients diagnosed with migraine without any types of aura in group B. These patients were referred to our neurology clinic of one of private hospitals in Tehran. Demographic data and thorough neurological examination performed and they underwent 1.5 Tesla MRI for further assessment of neuro-structures by an expert blinded neuro-radiologist. Statistical analysis was performed by SPSS 17.0 program using Student's T-test and Chi-square test. Results: In group A, there were 9 males and 31 females with mean age of 34.3 years, while there were 13 males and 27 females with mean age of 37.6 years in group B. (P value=0.08) Twenty-five patients in group A experienced visual symptoms, followed by 9 patients with sensory symptoms and 6 patients with motor symptoms. MRI study for group A revealed normal neuro-imaging in 18, pineal and choroid plexus calcification in 8, hyperintense lesions on optic nerve and tract in 4, vascular malformation in 4, hyperintense signal on centrum semiovale in 3 and lateral ventricle asymmetry in 3 patients. While MRI study in group B revealed normal neuro-imaging in 24, hyperintense signal on centrum semiovale in 6 and lateral ventricle asymmetry in 4, dilated ventricles defined by Evans' ratio in 3, pineal and choroid plexus calcification in 2 and brain tumor consistent with meningioma in 1 patient. Conclusion: Authors have found that some specific MRI pattern such as hyperintense lesions on optic nerve and tract and vascular malformation were exclusive to patients who experienced migraine with aura. Also we have noticed that patients without aura tend to have more normal neuro-imaging rather than patients with aura experience. Also we have found that pineal and choroid plexus calcifications were frequent in patients with migraine and aura experience. These findings, especially hyperintense lesions on optic nerve may prompt further evaluation for possible underlying demyelinating and auto-inflammatory and/or auto-immune diseases.

Choroid plexus function in neurological homeostasis and disorders: The awakening of the circadian clocks and orexins

“… 118 Using MRI, Janamiri et al. (2018) have demonstrated that CP calcification is common in patients with migraine and aura experiences, 119 suggesting that calcification of CP cells may be responsible for the dysfunction in CP transport and disruption to CSF homeostasis.…”

“…114,115 A plethora of research has demonstrated that increased extracellular Na þ is associated with hyper-excitability and migraine attacks, 116,117 with differential equation modelling confirming that the most likely cause of these changes in brain tissue and CSF Na þ concentrations are perturbations to the CP transport system. 118 Using MRI, Janamiri et al (2018) have demonstrated that CP calcification is common in patients with migraine and aura experiences, 119 suggesting that calcification of CP cells may be responsible for the dysfunction in CP transport and disruption to CSF homeostasis.…”