Migraine, White Matter Hyperintensities, and Subclinical Brain Infarction
Teshamae Monteith, MD, Hannah Gardener, ScD, Chuanhui Dong, Ph.D, Maria Santiago, Mitchell Elkind, MD, MS, FAAN, Tatjana Rundek, MD, PhD, Ralph Sacco, MD, MS, FAHA, FAAN and Clinton Wright, MD
Keywords: Migraine Disorders, Ethnic Groups, Epidemiology, Cerebral Infarction, Risk Factors
Objective: To examine the association between migraine and subclinical cerebrovascular measures in a race/ethnically diverse population-based cohort study.
Background: Migraine is a complex, inherited, and disabling brain disorder with no biomarkers available to aid in the diagnosis. Epidemiological studies suggest that migraine is a risk factor for white matter hyperintensities and silent brain infarctions on structural MRI.
Methods: In the Northern Manhattan Study, stroke-free participants underwent quantitative assessment of WMH volume (WMHV) and SBI. We examined features of SBI and WMHV in those with migraine without aura (MwO) and migraine with aura (MA) in a subset of participants with information on migraine determined by self-report using questions based on the ICHD-2 criteria. We examined the association between migraine overall (MO), MA, and MwO, with WMHV using linear regression, and with SBI using logistic regression.
Results: Out of the 546 study participants (41% male, mean age at baseline=65 ±8 yrs and MRI=71 ±8 yrs, 72% Hispanic), 104 (19%) were classified as having migraines at baseline, 6% with MA, and 13% with MwO. At the time of MRI, 56 of the 546 (10%) had SBI, of whom 15 also had migraines, only 2 with MA. The three most frequent SBI locations were the frontal white matter (13%), cerebellum (10%), and frontal cortex (7%). When controlling for demographics, those with MO at baseline had a 2.2-fold increased odds of SBI (95% CI 1.2-4.4). The association was stronger among those with MwO (vs. no migraine OR 2.8, 95% CI 1.4-5.8). The associations persisted after controlling for vascular risk factors (MO vs. no migraine OR, 95% CI=2.1, 1.0-4.3; MwO vs. no migraine OR, 95% CI=2.6, 1.2-5.7). No association was observed between migraine and WMHV. The analysis for MA did not show a significant association, but was under-powered.
Conclusion: SBI in migraine may be due to non-vascular etiologies. These results suggest that MwO is associated with SBI, but not WMHV.