The prevalence of MRI hyperintensity in migraine patients and its association with cardiovascular risk factors

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SCIENCE
The prevalence of MRI hyperintensity in migraine patients and its association with cardiovascular risk factors
Key Take-Away: 
  • Disease duration has a role in the formation of hyperintense brain lesions.
  • Cardiovascular risk factors do not affect the presence or absence of hyperintense lesions, suggesting that the relationship between migraine and these lesions may be directly due to the effects of migraine itself.

Migraine is a chronic and recurrent vascular headache affecting most of the population. It is associated with various co morbidities, structural brain lesions also seem to be linked to the disease. Evidence suggests that migraine is associated with an increased risk of silent infarct lesions and high signal intensities observed during magnetic resonance imaging (MRI). 

ABSTRACT: 
Background: 

Migraine is a chronic and recurrent vascular headache affecting most of the population. It is associated with various co morbidities, structural brain lesions also seem to be linked to the disease. Evidence suggests that migraine is associated with an increased risk of silent infarct lesions and high signal intensities observed during magnetic resonance imaging (MRI).

These hyperintense lesions are considered ischemic which is logical, given their association with vascular risk factors suggesting the need to investigate the risk factors associated with brain lesions in MRI of migraine headache patients.

Rationale behind research

  • Several studies have investigated the risk factors associated with brain lesions in MRI of migraine headache patients although consensus is yet to be reached on this matter
  • Objective

To evaluate the frequency of infract lesions in the MRI of migraine patients and identify the relationship between migraine characteristics and other clinical risk factors

Methods: 

 

NOTE: This was a prospective cross-sectional study in which face to face interview and standardized questionnaires were employed and subsequently brain MRI was performed to evaluate hyperintense lesions.

Study outcomes

  • Headache severity, frequency and mean disease duration
  • Hyperintense lesions evaluated by MRI
Results: 

 

Outcomes

  • Out of 90 patients, 29 (32%) had silent hyperintense lesions on their MRI. The mean age of the patients with hyperintense foci was 41 years and with no lesions was 33 years (p<0.010)
  • Supratentorial hyperintense lesions represented majority of lesions in the patients (n=46, 63%) and 56.2% of the lesions (n=41) were located in right hemisphere
  • Cardiovascular risk factors such as smoking, serum cholesterol, oral contraceptive use and body mass index were not significantly different (p>0.050).
  • The lesions were found significantly more frequently in patients who experienced chronic migraine (p=0.032) as compared to the patients with episodic pain.
  • No meaningful relationship was detected between overall headache, frequency and headache intensity, the presence of aura, sumatriptan dosage, duration of prophylactic medications and headache location.
Conclusion: 

The study adds weight to the theory that disease duration has a key role in the formation of hyperintense brain lesions. Certain cardiovascular risk factors such as sex, smoking, serum cholesterol, and BMI, do not affect the presence or absence of such lesions, suggesting that the relationship between migraine and these lesions may be directly due to the effects of migraine itself.

Results are consistent with the results of another study showing significant association between hyperintense lesions and age, severity of migraine and headache duration according to MRI. 

Oman Medical Journal. 2015; 30(3):203-207
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