The Prevalence of Magnetic Resonance Imaging Hyperintensity in Migraine Patients and Its Association with Migraine Headache Characteristics and Cardiovascular Risk Factors

Analysis of the relationships between the degree of migraine with right-to-left shunts and changes in white matter lesions and brain structural volume

To investigate the location of white matter lesions (WMLs) in migraineurs with right‒to‒left shunts (RLS); the relationships among the severity of WMLs, changes in brain structural volume and RLS shunts; and the relationships among the severity of WMLs, changes in brain structural volume and degree of headache in RLS migraine patients. A total of 102 migraineurs with RLS admitted to the affiliated Central Hospital of Dalian University of Technology from December 2018 to December 2022 were enrolled in this study. RLS flow and the 6-item Headache Impact Test (HIT-6) scores were recorded to reflect the degree of headache. The brain structural volumes of 102 migraineurs with RLS were calculated from T1-weighted images via artificial intelligence, and the brain structural volumes of healthy controls matched according to age and sex were also calculated. The correlations among WML location, RLS, headache degree, WML severity and brain structural volume changes in migraineurs were analyzed. (1) The WMLs of migraineurs with RLS were concentrated mainly in the white matter of the lateral ventricular margin and deep white matter. Subcortical WMLs were concentrated mainly in the parietal lobe, occipital lobe and frontal lobe. (2) There were no significant differences in the WML variables of cerebral white matter high signal volume, ratio of high-signal white matter volume to whole-brain white matter volume (%) or Fazekas score among migraineurs with different RLS flows, but there were significant differences in WML variables among migraineurs with RLS with different HIT-6 grades and MIDAS grades. RLS flow, HIT-6 score and MIDAS grade were not correlated with the WML variables measured in this study. (3) There was a significant difference in the volume of the precentral gyrus between migraineurs with RLS and normal controls (P < 0.001), and there was a significant difference between migraineurs with different RLS flows and different HIT-6 scores and peripheral cerebrospinal fluid volumes. There was also a positive correlation between frontal pole structural volume and RLS flow. The volume of the precentral gyrus was negatively correlated with RLS flow, whereas the volume of the pons gyrus was positively correlated with the HIT-6 score. The volume of the temporal pole was negatively correlated with the HIT-6 score. (1) The WMLs of migraineurs with RLS were concentrated mainly in the white matter of the lateral ventricular margin and deep white matter. Subcortical WMLs were concentrated mainly in the parietal lobe, occipital lobe and frontal lobe. (2) There was no correlation between WML severity and RLS flow in migraineurs with RLS. (3) There was no correlation between WML severity and migraine severity in migraineurs with RLS. (4) Volume changes occurred in some brain structures of migraineurs with RLS. (5) Shunt flow and the degree of headache in migraineurs with RLS were correlated with structural volume changes in specific brain regions.

Association of white matter hyperintensities with migraine phenotypes and response to treatment

INTRODUCTION

White matter hyperintensities (WMHs) are frequently found in migraineurs. However, their clinical significance and correlation to different migraine phenotypes and treatment responses are not well defined. The study aimed to examine the association of WMHs with migraine clinical patterns and treatment response.

AIM OF WORK

We aimed to evaluate the association between WMHs and migraine phenotypes and explore the relationship of WMHs to treatment response.

METHODS

Our cross-sectional study formed of 500 migraineurs who sought treatment in Kafr el-sheik university hospital and underwent (3 T) MRI to evaluate WMHs. Different migraine phenotypes were compared between patients with and without WMHs. According to reduced headache pain intensity and frequency, these patients were divided into treatment responder and non-responder groups.

RESULTS

A total of 145 patients (29%) had WMHs. Patients with WMHs were significantly older, had a longer disease duration, and higher attack frequency. Patients who did not respond to acute and maintenance medications had a higher frequency of WMHs and high WMHs Scheltens score. Migraine with Aura and the presence of vomiting and dizziness were predictors for the development of WMHs.

CONCLUSION

WMHs are more common in migraine with aura. It is more frequent in migraine associated with vomiting and dizziness. WMHs increased with advancing age and more severe disease burden. Poorer response to acute and prophylactic medications was found in patients with WMHs.

Prevalence and clinical characteristics of white matter hyperintensities in Migraine: A meta-analysis

BACKGROUND

Current evidences show an increased risk of white matter hyperintensities (WMHs) in migraineurs compared to age-matched controls. However, WMHs prevalence and the associations between WMHs and clinical characteristics in migraineurs have not been systematically evaluated using a meta-analytical approach. This study explored the pooled prevalence of WMHs and the associations of WMHs with the clinical characteristics in patients with migraine.

METHODS

A systematic review and meta-analysis of observational studies reporting the occurrence and clinical characteristics of patients with WMHs attributed to migraine was performed. We searched the PubMed, Web of Science, and Embase databases. Random-effects models were used to calculate the pooled prevalence rate, odds ratio (OR), or mean difference (MD) with corresponding 95% confidence intervals (CIs).

RESULTS

Thirty eligible studies were identified including 3,502 migraineurs aged 37.2 (mean) years. The pooled WMHs prevalence was 44 %, 45 %, and 38 % in migraine, migraine with aura, and migraine without aura groups, respectively. In migraineurs with WMHs, the frontal lobe and subcortical white matter were the most susceptible area. Compared with non-migraine controls, patients with migraine had increased odds for WMHs (OR 4.32, 95 % CI = 2.56-7.28, I2 = 67 %). According to reported univariable results from included studies, pooled analysis showed that clinical characteristics including age, presence of aura, disease duration, hypertension, diabetes mellitus and right-to-left shunt were associated with the presence of WMHs. Migraine pain and aura characteristics were not related to WMHs.

CONCLUSIONS

These data suggest that WMHs are common in migraine, especially in those who are older or have aura, hypertension, diabetes mellitus, or right-to-left shunt. A better understanding of the WMHs attributed to migraine is needed in future studies.

Association of LTA and SOD Gene Polymorphisms with Cerebral White Matter Hyperintensities in Migraine Patients

White matter hyperintensities (WMHs) in migraine could be related to inflammatory and antioxidant events. The aim of this study is to verify whether migraine patients with WMHs carry a genetic pro-inflammatory/pro-oxidative status. To test this hypothesis, we analyzed lymphotoxin alpha (LTA; rs2071590T and rs2844482G) and superoxide dismutase 1 (SOD1; rs2234694C) and 2 (SOD2; rs4880T) gene polymorphisms (SNPs) in 370 consecutive patients affected by episodic (EM; n = 251) and chronic (CM; n = 119) migraine and in unrelated healthy controls (n = 100). Brain magnetic resonance was available in 183/370 patients. The results obtained show that genotypes and allele frequencies for all tested SNPs did not differ between patients and controls. No association was found between single SNPs or haplotypes and sex, migraine type, cardiovascular risk factors or disorders. Conversely, the LTA rs2071590T (OR = 2.2) and the SOD1 rs2234694C (OR = 4.9) alleles were both associated with WMHs. A four-loci haplotype (TGCT haplotype: rs2071590T/rs2844482G/rs2234694C/rs4880T) was significantly more frequent in migraineurs with WMHs (7 of 38) compared to those without WMHs (4 of 134; OR = 8.7). We may, therefore, conclude by suggesting that that an imbalance between pro-inflammatory/pro-oxidative and antioxidant events in genetically predisposed individuals may influence the development of WMHs.

Risk factors of white matter hyperintensities in migraine patients

Background

Migraine frequently is associated with White Matter Hyperintensities (WMHs). We aimed to assess the frequency of WMHs in migraine and to assess their risk factors.

Methods

This is cross-sectional study included 60 migraine patients of both genders, aged between 18 and 55 years. Patients with vascular risk factors were excluded. We also included a matched healthy control group with no migraine. Demographic, clinical data, and serum level of homocysteine were recorded. All subjects underwent brain MRI (3 Tesla).

Results

The mean age was 38.65 years and most of our cohort were female (83.3). A total of 24 migraine patients (40%) had WMHs versus (10%) in the control group, (P < 0.013). Patients with WMHs were significantly older (43.50 + 8.71 versus. 35.92+ 8.55 years, P < 0.001), have a longer disease duration (14.54+ 7.76versus 8.58+ 6.89 years, P < 0.002), higher monthly migraine attacks (9.27+ 4. 31 versus 7.78 + 2.41 P < 0.020) and high serum homocysteine level (11.05+ 5.63 versus 6.36 + 6.27, P < 0.006) compared to those without WMHs. WMHs were more frequent in chronic migraine compared to episodic migraine (75% versus 34.6%; P < 0.030) and migraine with aura compared to those without aura (38.3% versus 29,2; P < 0.001). WMHs were mostly situated in the frontal lobes (83.4%), both hemispheres (70.8%), and mainly subcortically (83.3%).

Conclusion

Older age, longer disease duration, frequent attacks, and high serum homocysteine level are main the risk factors for WMHs in this cohort. The severity or duration of migraine attacks did not increase the frequency of WMHs. The number of WMHs was significantly higher in chronic compared to episodic migraineurs.

Migraine in patients with rheumatoid arthritis and its relation to disease activity

Background

The comorbidity between rheumatoid arthritis (RA) and migraine is complex and not completely understood.

Objective

This study aimed to evaluate migraine frequency in patients with RA and its relation to disease activity.

Methods

A cross-sectional study was carried out on 210 consecutive RA Egyptian patients fulfilling the 2010 EULAR/ACR criteria (joint distribution, serology, symptom duration and acute phase reaction).

Results

Prevalence of migraine in RA was 28.2%. Disease activity, fibromyalgia and functional losses were significantly higher in migraine group with RA versus non-migraine group (P < 0.001). Disease Activity Score (DAS-28) was independently significant predictor as increasing DAS-28 score was associated with an increased likelihood of exhibiting migraine (5.5-times higher odds per one-unit increase in DAS-28 score). Prevalence of brain MRI white matter hyper-intensities (WMHs) in RA with migraine was 54.8%. WMHs were significantly higher in migraine patients with aura than migraine patients without aura, especially in older patients, longer migraine duration, longer rheumatoid duration and elevated ESR (p < 0.047, p < 0.034, P < 0.004, P < 0.015 and P < 0.22, respectively).

Conclusions

Migraine is highly frequent in RA patients, especially migraine with aura. The presence of rheumatoid activity, fibromyalgia and secondary Sjogren’s syndrome, elevated ESR and CRP are associated with functional losses in RA patients with migraine, especially migraine with aura. MR imaging of brain is a mandatory tool for detection of white matter hyper-intensities in RA patients with migraine, especially migraine with aura.

White matter hyperintensity in different migraine subtypes

The diagnostic value of white matter hyperintensities (WMH) in different types of migraineare unknown. To evaluate the WMH pattern of different subtypes in migraine patients with no vascular risk factors. 92 migraine patients (73 females, mean age 34.6 ± 8.9; 61 episodic migraine, 31 chronic migraine, 36 migraine with aura, 56 migraine without aura) without vascular risk factors underwent brain MRI (3 T). We also included a matched healthy control group with no migraine (n = 24). The prevalence of WMH in different types of migraine was similar and ranged from 38.7 to 44.4%; the control group showed no WMH at all. Lesions were located within frontal, parietal and temporal lobes (in order of decreasing incidence) in juxtacortical and/or deep white matter. WMH appeared as round or slightly elongated foci with a median size of 2.5 mm [1.5; 3]. Total number, size and prevalence of WMH by lobes and white matter regions were similar between groups, and no interaction with age or sex was found. The number of lesions within the frontal lobe juxtacortical white matter correlated with the age of patients (r = 0.331, p = 0.001) and the duration since migraine onset (r = 0.264, p = 0.012). Patients with different migraine subtypes and without vascular risk factors are characterized by a similar pattern of WMH in the absence of subclinical infarctions or microbleedings. Therefore, WMH have no relevant prognostic value regarding the course of migraine and vascular complications. WMH pattern may be used to differentiate migraine as a primary disorder and other disorders with migraine-like headache and WMH.

From transformation to chronification of migraine: pathophysiological and clinical aspects

Chronic migraine is a neurological disorder characterized by 15 or more headache days per month of which at least 8 days show typical migraine features. The process that describes the development from episodic migraine into chronic migraine is commonly referred to as migraine transformation or chronification. Ample studies have attempted to identify factors associated with migraine transformation from different perspectives. Understanding CM as a pathological brain state with trigeminovascular participation where biological changes occur, we have completed a comprehensive review on the clinical, epidemiological, genetic, molecular, structural, functional, physiological and preclinical evidence available.

White Matter Hyperintensities in Patients with Sporadic Hemiplegic Migraine

BACKGROUND AND PURPOSE

To identify the differences in overall occurrence, location, and disease burden of white matter hyperintensities (WMH) in patients with sporadic hemiplegic migraine (SHM) and patients with migraine headaches.

METHODS

We included patients who met diagnostic criteria proposed by the third International Classification of Headache Disorders (ICHD-3) for SHM and migraine headache. WMHs were identified using T2 fluid-attenuated inversion recovery axial sequence and classified based upon the location. The disease burden was assessed using Scheltens visual rating scale.

RESULTS

Fifty patients met the diagnostic criteria for SHM and 100 patients for migraine headache. Patients in the study group were similar to the control group in terms of age (47.7 ± 12.2 years vs. 48.17 ± 9.7 years; P = .814) and gender (M: F; 14:36 vs. M: F 25:75; P = .693). WMH were found in 28 (56%) patients with SHM and 44 (44%) in patients with migraine headache. The proportion of patients with WMH was not different between the two groups (P = .166). On univariate analysis, the proportion of patients with WMH in parietal, occipital, and infratentorial regions was higher in patients with SHM. White matter burden determined by visual rating scale and proportion of patients with lesions ≥5 mm in diameter was also significantly higher in patients with SHM. On multivariate analysis, the WMH occurrence in the parietal lobe (P = .043) was found to be significantly higher in SHM.

CONCLUSIONS

The WMH occurrence in patients with SHM is significantly more in the parietal lobe when compared to those with migraine headaches. WMH burden was also higher in patients with SHM, and larger white matter lesions occurred more frequently in these patients with SHM (compared to ordinary migraineurs).

Characteristics and clinical correlates of white matter changes in brain magnetic resonance of migraine females

OBJECTIVE

White matter hyperintensities (WMHs) were often found in migraine patients. The aim of study was to characterize WMHs, assess their prevalence, determine relationship to clinical symptoms and homocysteine levels in migraine females.

METHODS

69 women 38 with migraine without aura (MO), 31 with migraine with aura (MA) who underwent brain MRI with 1.5T scanner were enrolled. The WMHs number, location and size in FLAIR sequence were evaluated. Migraine severity was measured by pain intensity, number of attacks per month and MIDAS scale.

RESULTS

WMHs were found in 39.1% females. There was no WMHs and migraine type correlation. The total WMHs number was higher in MO (p=0.027). Patients with WMHs were older (p=0.025), have higher BMI (p=0.042), suffered longer (p=0.001), more often had positive pregnancy history (p=0.010) and less frequent prodromal symptoms. The age of onset, migraine's severity and homocysteine did not correlate with WMHs. No effect of antimigraine medication and oral contraceptive pills (OCP) was found. Both in MO and MA groups WMHs were located only supratentorially. In MO females WMHs were mainly located in one cerebral hemisphere (p=0.024) whereas in MA were found bilaterally. WMHs were most commonly located in the frontal lobes. In MO lesions were small ≤3mm and present in almost all MO patients (p=0.027).

CONCLUSION

WMHs are present in more than one third of migraine females, regardless of aura. WHMs are located supratentorially, subcortically and in the frontal lobes. Older age, longer disease's duration, obesity and positive history of pregnancy are main risk factors for WMHs. Symptomatology and migraine severity, hyperhomocysteinemia, OCP and anti-migraine medications do not increase WMHs.

Relation between migraine pattern and white matter hyperintensities in brain magnetic resonance imaging

Background

Migraine is a common disorder in general population. Presence of white matter hyperintensities (WMHs) in brain MRI of migraine patients was not studied clearly. Detection of the prevalence of white matter hyperintensities in migraine patients determines its correlation with migraine severity, type and duration.

Methods

Cross sectional analytic study was conducted on migraine patients attending neurology clinic Suez Canal University Hospital. Sixty-five patients with migraine aged from 18 to 50 years were included. We excluded smokers and patients with hypertension, cardiac disease, diabetes mellitus, endocrine dysfunction, oncological and hematological diseases, infectious diseases, demyelinating disorders, and Alzheimer disease. Brain MRI and laboratory investigation was done for all patients.

Results

White matter hyperintensities were significant more frequent in migraine with aura than those without aura. According to MIGSEV scale, white matter hyperintensities were highly significantly more frequent in grade III severity than grades II and I. The number of white matter hyperintensities increases significantly with increase intensity of pain during attack. The number of white matter hyperintensities increases significantly with increase intensity of nausea, disability, tolerability during attack and age. Resistance to treatment also shows statistically significant difference in increase number of WMHs.

Conclusions

White matter hyperintensities are present in 43.1% of migraine patients. Age, presence of aura, nausea, disability during attack, resistance to treatment, and severity of headache and duration of migraine are considered a risk factor for development of white matter hyperintensities.

Association of white matter hyperintensities with migraine features and prognosis

Background

White matter hyperintensities (WMHs) are frequently detected in migraine patients. However, their significance and correlation to migraine disease burden remain unclear. This study aims to examine the correlation of WMHs with migraine features and explore the relationship between WMHs and migraine prognosis.

Methods

A total of 69 migraineurs underwent MRI scans to evaluate WMHs. Migraine features were compared between patients with and without WMHs. After an average follow-up period of 3 years, these patients were divided into two groups, according to the reduction of headache frequency: improved and non-improved groups. The percentage and degree of WMHs were compared between these two groups.

Results

A total of 24 patients (34.8%) had WMHs. Patients with WMHs were significantly older (39.0 ± 7.9 vs. 30.6 ± 10.4 years, P < 0.001) and had a longer disease duration (median: 180.0 vs. 84.0 months, P = 0.013). Furthermore, 33 patients completed the follow up period (15 patients improved and 18 patients did not improve). Patients in the non-improved group had a higher frequency of WMHs (55.6% vs. 13.3%, P = 0.027) and median WMHs score (1.0 vs. 0.0, P = 0.030).

Conclusions

WMHs can predict unfavorable migraine prognosis. Furthermore, WMHs may have a closer association with age than migraine features.

Advances in migraine neuroimaging and clinical utility: from the MRI to the bedside

INTRODUCTION

In current migraine clinical practice, no specific diagnostic investigations are available and therefore the diagnosis is an eminently clinical process where instrumental examinations may have a part to exclude possible causes of secondary headaches. While migraine clinical phenotype has been widely characterized, migraine pathophysiology has still a gap that might be partly bridged by structural and functional neuroimaging investigations. Areas covered: This article aims to review the recent advances in functional neuroimaging, the consequent progress in the knowledge of migraine pathophysiology and their putative application and impact in the clinical setting. A comprehensive review was conducted of PubMed citations by entering the key word 'MRI' combined with 'migraine' AND/OR 'headache.' Other key words included 'gray matter' OR 'white matter,' 'structural' OR 'functional.' The only restriction was English-language publication. The abstracts of all articles meeting these criteria were reviewed, and full texts were examined for relevant references. Expert commentary: Advanced magnetic resonance imaging (MRI) techniques are tremendously improving our knowledge about brain abnormalities in migraine patients. However, advanced MRI could nowadays overcome the limits linked to the clinicians' judgment through the identification of objectively measurable neuroimaging findings (quantitative biomarkers) concerning the diagnosis, the prognosis and 'tailored' therapeutic-care pathways.

Hypertension and Migraine in the Northern Manhattan Study

OBJECTIVE

To investigate the association between migraine and hypertension in the Northern Manhattan Study (NOMAS), a multiethnic community-based sample.

DESIGN

Cross-sectional cohort study.

PARTICIPANTS

1338 NOMAS participants (mean age 68.1 ± 9.6 years, 37% male, 15% non-Hispanic White, 19% non-Hispanic Black, 67% Hispanic).

SETTING

Northern Manhattan community.

INTERVENTION

Participants were assessed for migraine symptoms using a self-report questionnaire based on criteria from the International Classification of Headache Disorders. Hypertension was defined as blood pressure ≥140/90 mm Hg, the patient's self-reported hypertension, or use of anti-hypertensive medications. Duration (≤9 years vs >9 years) and control (BP<140/90) of hypertension were examined. We estimated the association between hypertension and migraine (overall and with/without aura) using logistic regression, adjusting for sociodemographic and vascular risk factors.

RESULTS

The majority of participants (80%) had no migraine, 6% had migraine with aura, and 15% had migraine without aura. Hypertension was present in 76% of the study population (7% had controlled hypertension ≤9 years duration, 5% controlled hypertension >9 years duration, 41% uncontrolled hypertension ≤9 years duration, 23% uncontrolled hypertension >9 years duration). Hypertension was associated with migraine (OR: 1.76, 95% CI: 1.21-2.54), both with and without aura. This association was particularly apparent for those with uncontrolled and long duration hypertension.

CONCLUSION

Hypertension, particularly uncontrolled and of long duration, is associated with migraine, both with and without aura, in a predominantly Hispanic community-based cohort.