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BMC Neurology
Published in: BMC Neurology 1/2022

Open Access 01-12-2022 | Migraine | Research

Risk factors of white matter hyperintensities in migraine patients

Authors: Jasem Yousef Al-Hashel, Raed Alroughani, Khaled Gad, Lamiaa Al-Sarraf, Samar Farouk Ahmed

Published in: BMC Neurology | Issue 1/2022

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Abstract

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.
Literature
1.
2.
3.
Al-Hashel JY, Ahmed SF, Alroughani R. Prevalence of primary headache disorders in Kuwait. Neuroepidemiology. 2017;48(3–4):138–46.PubMedCrossRef
4.
Maleki N, Gollub RL. What have we learned from brain functional connectivity studies in migraine headache? Headache. 2016;56(3):453–61.PubMedCrossRef
5.
Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97(2):553–622.PubMedPubMedCentralCrossRef
6.
Chen Z, Chen X, Liu M, Liu S, Ma L, Yu S. Disrupted functional connectivity of periaqueductal gray subregions in episodic migraine. J Headache Pain. 2017;18(1):1–9.CrossRef
7.
8.
Neeb L, Bastian K, Villringer K, Israel H, Reuter U, Fiebach JB. Structural gray matter alterations in chronic migraine: implications for a progressive disease? Headache. 2017;57(3):400–16.PubMedCrossRef
9.
Kruit MC, van Buchem MA, Hofman PA, Bakkers JT, Terwindt GM, Ferrari MD, et al. Migraine as a risk factor for subclinical brain lesions. JAMA. 2004;291(4):427–34.PubMedCrossRef
10.
11.
Trauninger A, Leél-Őssy E, Kamson DO, Pótó L, Aradi M, Kövér F, et al. Risk factors of migraine-related brain white matter hyperintensities: an investigation of 186 patients. J Headache Pain. 2011;12(1):97–103.PubMedPubMedCentralCrossRef
12.
Toghae M, Rahimian E, Abdollahi M, Shoar S, Naderan M. The prevalence of magnetic resonance imaging hyperintensity in migraine patients and its association with migraine headache characteristics and cardiovascular risk factors. Oman Med J. 2015;30(3):203.PubMedPubMedCentralCrossRef
13.
Zhang Q, Datta R, Detre JA, Cucchiara B. White matter lesion burden in migraine with aura may be associated with reduced cerebral blood flow. Cephalalgia. 2017;37(6):517–24.PubMedCrossRef
14.
Uggetti C, Squarza S, Longaretti F, Galli A, Di Fiore P, Reganati PF, et al. Migraine with aura and white matter lesions: an MRI study. Neurol Sci. 2017;38(1):11–3.PubMedCrossRef
15.
Friedman DI, Dodick DW. White matter hyperintensities in migraine: reason for optimism. JAMA. 2012;308(18):1920–1.PubMedCrossRef
16.
Kurth T, Mohamed S, Maillard P, Zhu YC, Chabriat H, Mazoyer B, Bousser MG, Dufouil C, Tzourio C. Headache, migraine, and structural brain lesions and function: population based Epidemiology of Vascular Ageing-MRI study. Bmj. 2011;342.
17.
Eggers AE. Migraine white matter hyperintensities and cerebral microinfarcts are silent cryptogenic strokes and relate to dementia. Med Hypotheses. 2017;102:1–3.PubMedCrossRef
18.
Moschiano F, D’Amico D, Usai S, Grazzi L, Di Stefano M, Ciusani E, et al. Homocysteine plasma levels in patients with migraine with aura. Neurol Sci. 2008;29(1):173–5.CrossRef
19.
Bautista LE, Arenas IA, Peñuela A, Martinez LX. Total plasma homocysteine level and risk of cardiovascular disease: a meta-analysis of prospective cohort studies. J Clin Epidemiol. 2002;55(9):882–7.PubMedCrossRef
20.
Casas JP, Bautista LE, Smeeth L, Sharma P, Hingorani AD. Homocysteine and stroke: evidence on a causal link from mendelian randomisation. Lancet. 2005;365(9455):224–32.PubMedCrossRef
21.
Collaboration HS. Homocysteine and risk of ischemic heart disease and stroke. JAMA. 2002;288(16):2015–2.CrossRef
22.
Kara I, Sazci A, Ergul E, Kaya G, Kilic G. Association of the C677T and A1298C polymorphisms in the 5, 10 methylenetetrahydrofolate reductase gene in patients with migraine risk. Mol Brain Res. 2003;111(1–2):84–90.PubMedCrossRef
23.
Lea R, Colson N, Quinlan S, Macmillan J, Griffiths L. The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability. Pharmacogenet Genomics. 2009;19(6):422–8.PubMedCrossRef
24.
Menon S, Lea RA, Roy B, Hanna M, Wee S, Haupt LM, et al. Genotypes of the MTHFR C677T and MTRR A66G genes act independently to reduce migraine disability in response to vitamin supplementation. Pharmacogenet Genomics. 2012;22(10):741–9.PubMedCrossRef
25.
Sachdev P, Parslow R, Salonikas C, Lux O, Wen W, Kumar R, et al. Homocysteine and the brain in midadult life: evidence for an increased risk of leukoaraiosis in men. Arch Neurol. 2004;61(9):1369–76.PubMedCrossRef
26.
Dufouil C, Alpérovitch A, Ducros V, Tzourio C. Homocysteine, white matter hyperintensities, and cognition in healthy elderly people. Ann Neurol. 2003;53(2):214–21.PubMedCrossRef
27.
Vermeer SE, Van Dijk EJ, Koudstaal PJ, Oudkerk M, Hofman A, Clarke R, et al. Homocysteine, silent brain infarcts, and white matter lesions: the Rotterdam scan study. Ann Neurol. 2002;51(3):285–9.PubMedCrossRef
28.
Aicher B, Peil H, Peil B, Diener HC. Pain measurement: Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS) in clinical trials with OTC analgesics in headache. Cephalalgia. 2012;32(3):185–97.PubMedCrossRef
29.
Hung P, Fuh J, Wang S. The application of migraine disability assessment questionnaire (MIDAS). Acta Neurol Taiwanica. 2006;15(1):43.
30.
Kosinski M, Bayliss MS, Bjorner JB, Ware JE, Garber WH, Batenhorst A, et al. A six-item short-form survey for measuring headache impact: the HIT-6™. Qual Life Res. 2003;12(8):963–74.PubMedCrossRef
31.
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment Moca: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.PubMedCrossRef
32.
Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F, Filippi M, Freedman MS, Fujihara K. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–73.
33.
Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–73.PubMedCrossRef
34.
35.
Gursoy-Ozdemir Y, Qiu J, Matsuoka N, Bolay H, Bermpohl D, Jin H, et al. Cortical spreading depression activates and upregulates MMP-9. J Clin Invest. 2004;113(10):1447–55.PubMedPubMedCentralCrossRef
36.
Colombo B, Dalla Libera D, Comi G. Brain white matter lesions in migraine: what’s the meaning? Neurol Sci. 2011;32(1):37–40.CrossRef
37.
Yemisci M, Eikermann-Haerter K. Aura and Stroke: relationship and what we have learnt from preclinical models. J Headache Pain. 2019;20(1):1–8.CrossRef
38.
Sparaco M, Feleppa M, Lipton RB, Rapoport AM, Bigal ME. Mitochondrial dysfunction and migraine: evidence and hypotheses. Cephalagia. 2006;26:361–72.CrossRef
39.
Negm M, Housseini AM, Abdelfatah M, Asran A. Relation between migraine pattern and white matter hyperintensities in brain magnetic resonance imaging. Egypt J Neurol Psychiatry Neurosurg. 2018;54(1):1–8.CrossRef
40.
Le Pira F, Reggio E, Quattrocchi G, Sanfilippo C, Maci T, Cavallaro T, et al. Executive dysfunctions in migraine with and without aura: what is the role of white matter lesions? Headache. 2014;54(1):125–30.PubMedCrossRef
41.
Xie H, Zhang Q, Huo K, Liu R, Jian ZJ, Bian YT, et al. Association of white matter hyperintensities with migraine features and prognosis. BMC Neurol. 2018;18(1):1–0.CrossRef
42.
43.
Alkhaffaf WH, Naif MM, Ahmed RN. The association of MRI findings in migraine with the headache characteristics and response to treatment. Revista Latinoamericana de Hipertension. 2020;15(5):345–51.
44.
Dobrynina LA, Suslina AD, Gubanova MV, Belopasova AV, Sergeeva AN, Evers S, et al. White matter hyperintensity in different migraine subtypes. Sci Rep. 2021;11(1):1–9.CrossRef
45.
Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010;375(9718):938–48.PubMedCrossRef
46.
47.
Seneviratne U, Chong W, Billimoria PH. Brain white matter hyperintensities in migraine: clinical and radiological correlates. Clin Neurol Neurosurg. 2013;115(7):1040–3.PubMedCrossRef
48.
Eikermann-Haerter K, Huang SY. White matter lesions in migraine. Am J Pathol. 2021;191(11):1955–62.PubMedCrossRef
49.
50.
Rocca MA, Colombo B, Inglese M, Codella M, Comi G, Filippi M. A diffusion tensor magnetic resonance imaging study of brain tissue from patients with migraine. J Neurol Neurosurg Psychiatry. 2003;74(4):501–3.PubMedPubMedCentralCrossRef
51.
Gavgani SC, Hoseinian MM. Comparative study on homocysteine levels in migraine patients and normal peoples. Ann Biol Res. 2012;3:1804–7.
52.
Wong TY, Klein R, Sharrett AR, Couper DJ, Klein BE, Liao DP, et al. Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA. 2002;288(1):67–74.PubMedCrossRef
53.
54.
Rao R, Tah V, Casas JP, Hingorani A, Whittaker J, Smeeth L, et al. Ischaemic stroke subtypes and their genetic basis: a comprehensive meta-analysis of small and large vessel stroke. Eur Neurol. 2009;61(2):76–86.PubMedCrossRef
55.
Swieten JV, HOUT JV, KETEL BV, Hijdra A, Wokke JH, Gijn JV. Periventricular lesions in the white matter on magnetic resonance imaging in the elderly: a morphometric correlation with arteriolosclerosis and dilated perivascular spaces. Brain. 1991;114(2):761–74.PubMedCrossRef
56.
Rościszewska-Żukowska I, Zając-Mnich M, Janik P. Characteristics and clinical correlates of white matter changes in brain magnetic resonance of migraine females. Neurol Neurochir Pol. 2018;52(6):695–703.PubMedCrossRef
57.
Sachdev P, Chen X, Wen W. White matter hyperintensities in mid-adult life. Curr Opin Psychiatry. 2008;21(3):268–74.PubMedCrossRef
Metadata
Title
Risk factors of white matter hyperintensities in migraine patients
Authors
Jasem Yousef Al-Hashel
Raed Alroughani
Khaled Gad
Lamiaa Al-Sarraf
Samar Farouk Ahmed
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-022-02680-8

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