Abstract
ObjectiveTo compare the prevalence of an incomplete circle of Willis in patients with migraine with aura, migraine without aura, and control subjects, and correlate circle of Willis variations with alterations in cerebral perfusion.MethodsMigraine with aura, migraine without aura, and control subjects were prospectively enrolled in a 1∶1∶1 ratio. Magnetic resonance angiography was performed to examine circle of Willis anatomy and arterial spin labeled perfusion magnetic resonance imaging to measure cerebral blood flow. A standardized template rating system was used to categorize circle of Willis variants. The primary pre-specified outcome measure was the frequency of an incomplete circle of Willis. The association between circle of Willis variations and cerebral blood flow was also analyzed.Results170 subjects were enrolled (56 migraine with aura, 61 migraine without aura, 53 controls). An incomplete circle of Willis was significantly more common in the migraine with aura compared to control group (73% vs. 51%, p = 0.02), with a similar trend for the migraine without aura group (67% vs. 51%, p = 0.08). Using a quantitative score of the burden of circle of Willis variants, migraine with aura subjects had a higher burden of variants than controls (p = 0.02). Compared to those with a complete circle, subjects with an incomplete circle had greater asymmetry in hemispheric cerebral blood flow (p = 0.05). Specific posterior cerebral artery variants were associated with greater asymmetries of blood flow in the posterior cerebral artery territory.ConclusionsAn incomplete circle of Willis is more common in migraine with aura subjects than controls, and is associated with alterations in cerebral blood flow.
Highlights
An estimated 28 million Americans suffer from disabling migraines
Circle of Willis variations have been associated with alterations in intracranial vessel blood flow volume and regional cerebral blood flow (CBF) [12,13]
To investigate the hypothesis that an incomplete circle of Willis is associated with migraine, we performed the Anatomy and Cerebral Hemodynamic Evaluation of Migraine (ACHE-M) study, using highresolution magnetic resonance angiography (MRA) to evaluate circle of Willis structure and arterial spin labeled (ASL) perfusion MRI to assess CBF in subjects with and without migraine
Summary
An estimated 28 million Americans suffer from disabling migraines. Beyond the immediate disability related to headache, migraine, with aura, has been associated with an increased risk of ischemic stroke [1,2,3,4,5,6,7]. While the trigger for initiation of CSD in migraine remains incompletely understood, some evidence suggests that alterations in cerebral blood flow may trigger both migraine and CSD [9,10]. Within this framework, one factor not previously well investigated is the contribution of structural alterations in the cerebral vasculature, variations in the circle of Willis, to migraine pathogenesis. We found that an incomplete circle of Willis is more common in migraine with aura subjects than controls, and is associated with alterations in cerebral blood flow
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