Migraine as a Risk Factor for Subclinical Brain Lesions

MIGRAINE IS A COMMON, chronic, multifactorial neurovascular disorder typically characterized by recurrent attacks of disabling headache and autonomic nervous system dysfunction (migraine without aura); up to one third of patients also have neurological aura symptoms (migraine with aura). Migraine has been suggested to be an independent risk factor for stroke, but the evidence is conflicting and seems to be restricted to certain subpopulations (eg, women with migraine with aura who are younger than 45 years, particularly ones who smoke or use oral contraceptives [OCs]). Case reports on patients with so-called migrainous infarction suggest that the posterior circulation territory (PCT) is most commonly affected. However, data are lacking on prevalence of subclinical infarcts in a wide spectrum of migraine patients in the general population. Patients with migraine may also be at increased risk of more diffuse subclinical lesions in the deep white matter or periventricular areas that are only detected on neuroimaging. Several clinic-based magnetic resonance imaging (MRI) studies have reported this, Author Affiliations: Departments of Radiology (Drs Kruit and van Buchem) and Neurology (Drs Terwindt and Ferrari), Leiden University Medical Center, Leiden, Department of Radiology, Academic Hospital Maastricht, Maastricht (Dr Hofman), and Department of Radiology, Slingeland Hospital, Doetinchem (Dr Bakkers), the Netherlands; and Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Md (Dr Launer). Corresponding Author and Reprints: Mark C. Kruit, MD, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands (e-mail: [email protected]). Context Clinical series have suggested an increased prevalence of cerebral infarction and white matter lesions (WMLs) in migraine patients. It is not known whether these lesions are prevalent in the general migraine population.