Migraine, Encephalopathy and Stroke Relationship
The Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) patients experience migraine commonly but its treatment responses are not well reported, and its relationship to stroke risk unrevealed. Encephalopathy is a less common presentation and has been proposed to be related to migraine.
The migraine patterns and treatment responses in CADASIL was specified and inspected associations between migraine and both stroke risk and encephalopathy.
From 1996 to 2015, 300 symptomatic CADASIL patients were prospectively engaged from a national referral clinic over a 19-year period. The data was retrieved from a standardized questionnaire. Migraine was classified as per the International Classification of Headache Disorders, 3rd edition (beta version). The data collected was analyzed using a cross-sectional analysis.
The outcomes lead to the fact that migraine was present in 226 (75.3%), and the presenting feature in 203 (67.7%). Generally, it was escorted by aura (89.8%). The patients manifested variable responses to a variety of drugs for migraine. 45.5% of the 24 given triptans had consistent or partial responses with no complications. Encephalopathy was experienced by 33 (11.0%) patients lasting on average 8.1 ± 3.4 days. Patients experiencing migraine with aura had higher odds of encephalopathy (OR = 5.4; 95%CI 1.6–28.4; p = 0.002). Patients with confusional aura had higher odds of encephalopathy than those with the other aura variety (OR = 2.5, 95%CI = 1.0–5.8, p = 0.04). At the beginning of migraine, there was also no increase in risk of encephalopathy with sex or age. Migraineurs had a lower stroke risk than non-migraineurs (HR = 0.46, 95%CI 0.3–0.6, p = 2.1x10-6).
Migraine with aura is a well-known feature of CADASIL. The treatment responses are comparable to those noticed in the general migraine population and no complications were observed with triptans. Migraine with aura was concerned with a high risk of encephalopathy suggesting it may be in equity with the pathophysiological mechanisms. There was no increased stroke risk corresponding with migraine, but risk appeared to be reduced although this finding needs confirming.