Abstract
Brain white matter hyperintensities are more prevalent in migraine patients than in the general population, but the pathogenesis and the risk factors of these hyperintensities are not fully elucidated. The authors analyzed the routine clinical data of 186 migraine patients who were referred to the Outpatient Headache Department of the Department of Neurology, Medical School, University of Pécs, Hungary between 2007 and 2009: 58 patients with white matter hyperintensities and 128 patients without white matter hyperintensities on 3 T MRI. Significant associations between the presence of white matter hyperintensities and longer disease duration (14.4 vs. 19.9 years, p = 0.004), higher headache frequency (4.1 vs. 5.5 attacks/month, p = 0.017), hyperhomocysteinemia (incidence of hyperintensity is 9/9 = 100%, p = 0.009) and thyroid gland dysfunction (incidence of hyperintensity is 8/14 = 57.1%, p = 0.038) were found. These data support the theory that both the disease duration and the attack frequency have a key role in the formation of migraine-related brain white matter hyperintensities, but the effects of comorbid diseases may also contribute to the development of the hyperintensities.
Highlights
Migraine is a complex disorder of the brain, and its pathomechanism is intensively investigated
When examining the association between the disease duration and the presence of white matter hyperintensities (WMH) according to migraine type, it was found that both migraine patients without and with aura have a longer disease duration with WMH, than patients without WMH (Table 1). 3
The proportion of migraine patients with WMH increased with the monthly migraine attack frequency (0–1 attack/month: n = 7/37, 18.9%, 2–7 attacks/month: n = 36/114, 31.5%, C8 attacks/month: n = 15/35, 42.9%), there was only a trend towards statistical significance (p = 0.08) when the patients were examined in three groups according to their attack frequency
Summary
Migraine is a complex disorder of the brain, and its pathomechanism is intensively investigated. Migraine patients have an almost fourfold greater risk to develop white matter lesions than non-migraine controls [5], and the prevalence of these lesions is higher in migraine with aura than in migraine without aura [4]. The risk of developing white matter lesions is higher in female migraineurs and in patients with higher attack frequency and longer disease duration [4, 6]. It seems that brain white matter lesions do not correlate with age [7, 8]. Since the risk of these severe complications is low in the general population, it is not possible to identify which migraine patients will develop a cerebrovascular or cardiovascular event [10]
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