No association between migraine frequency, white matter lesions and silent brain infarctions: a study in a series of women with chronic migraine.

A Meilán,J Pascual,D Larrosa,E Cernuda‐Morollón,P Martínez‐Camblor,A Saiz,C Ramón,E Santamarta,S Pérez‐Pereda

doi:10.1111/ene.14284

Abstract

It has been suggested that silent infarctions (SIs) and hyperintense white matter lesions (WMLs) are related to migraine frequency. We studied their prevalence and anatomical distribution in patients with chronic migraine (CM). A total of 96 women with CM [mean age 43 (range 16-65)years] and 29 women with episodic migraine (EM) [mean age 36 (range 16-58)years] underwent 1.5-T magnetic resonance imaging following the CAMERA protocol. The number, size and location of SIs and deep WMLs were recorded and a modified Fazekas scale was applied to assess periventricular WMLs. White matter lesions were found in 59 (61.5%) women with CM and 17 (58.6%) women with EM (odds ratio, 1.13; 95% confidence intervals, 0.48-2.62; P=0.784). The majority (63% CM and 71% EM) were small deep WMLs. Exclusive periventricular WMLs were exceptional. Of the 739 WMLs seen in patients with CM, 734 (99.3%) were hemispheric and mostly frontal (81%). Posterior fossa WMLs were seen in only five (5.2%) women with CM (always in the pons) and two (6.9%) women with EM. Age >45years was the only vascular risk factor associated with a higher WML number (median: 0<45years and 3>45years; P=0.004). We found seven SIs in six women with CM (6.3%). As compared with the expected prevalence at this age, this study confirms that the prevalence of WMLs, in most cases small, deep and frontal, was increased in CM and EM. However, our results do not support an association of WMLs or SIs with a higher frequency of attacks, but with the presence of vascular risk factors and mainly age >45years.

Highlights

Migraine is associated with a relevant burden, traditionally it has been contemplated as a condition without long-term consequences
Our data confirm that white matter lesions (WML) prevalence (60.8%) is increased in migraineurs when compared to that expected in the population [13,14], which should fall below 20% at the age of our series [4]
WML prevalence, was similar in chronic migraine (CM) (61.5%) and episodic migraine (EM) (58.6%) and statistics did not show an association between migraine type or headache frequency and WML

Summary

Introduction

Migraine is associated with a relevant burden, traditionally it has been contemplated as a condition without long-term consequences. Kruit et al found that, among migraine women, the risk of deep WML (dWML) load was significantly increased and that increased with attack frequency (OR= 2.6 with > 1 attack/month) [4]. It has been suggested that silent infarctions (SI) and hyperintense white matter lesions (WML) are related to migraine frequency. We studied their prevalence and anatomical distribution in chronic migraine (CM) patients. Age >45 was the only vascular risk factor (VRF) associated with a higher WML number (medians of 0 < 45 and of 3 >45 years, p= 0.004). Our results do not support an association of WML or SI with a higher frequency of attacks, but with the presence VRF and mainly age > 45 years

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