gms | German Medical Science

Introduction: Magnetic resonance imaging (MRI) study results, examining the association between migraine and the presence and progression of white matter hyperintensities of presumed vascular origin (WMH) as an indicator for cerebral small vessel disease, are inconsistent regarding the strength of the association and its clinical significance [1], [2]. The study aim was to investigate the association of migraine with (MigA+) and without aura (MigA-) with WMH and their progression in a population-based study sample.

Methods: Data of participants with known migraine status (MigA+, MigA-, non-migraine headache (nonMigHA), never headache (neverHA)) according to ICHD-II classification [3] and complete quantitative (volume [4]) and qualitative (Fazekas classification [5]) WMH data at first imaging (2011-2016, n=1062, 45% women, 60.9±13.0 years) and after 3.7±0.7 years (n=393) were analyzed. The sex-specific association between migraine status (reference: neverHA) and WMH volume (log-transformed) at study baseline and absolute WMH volume change was evaluated by linear regression (i.e. estimating back-transformed exp(β) and β, respectively, and 95%-confidence intervals [95%CI]) and between migraine status and Fazekas score (high: grade 2-3 vs. low: grade 0-1) by log-binomial regression (i.e., estimating prevalence ratios (PR) and 95%CI adjusted for confounders (age, smoking, BMI, sport, education).

Results: Lifetime prevalence of MigA+ and MigA- was higher in women than in men (MigA+: 14.6% vs. 7.2%, MigA-: 35.8% vs. 19.6%). Median WMH volume was lower in women than men (4005 (Q1: 2454; Q3: 6880) voxel vs. 4812 (2842; 8445) voxel). Cross-sectional analysis at first imaging: Compared to women without headache, women with MigA+ had a 1.29 [95%CI: 1.04; 1.59]-fold and with MigA- a 1.19 [0.99; 1.43]-fold higher WMH volume, but also women with nonMigHA had a higher volume (1.24 [1.04; 1.49]), fully adjusted. High deep white matter and periventricular Fazekas grading occurred more often only in women with MigA+ compared to neverHA (PR: 1.20 [0.83; 1.75] and 1.40 [0.95; 2.08]). Longitudinal analysis within 3.7 years: Only women with MigA+ had weak indication for more WMH volume progression than women without headache (767 [-304; 1838] voxel). Most of the reported 95%CI are wide. Male migraineurs did not have more WMH or progression compared to men without headache.

Discussion: Our results provide indication for a higher WMH volume in women with migraine and nonMigHA and weak indication for an association between MigA+ in women and the progression of WMH. The underlying pathomechanisms and the reason for the missing association in men are unclear. This requires further research. In particular, the question of previously unknown influencing factors in adolescence or young adulthood are of great interest.

Conclusion: There is some indication for an association between migraine and headache and the presence of WMH in women. Only for women with MigA+ there is also a weak indication for more WMH progression. In case of imaging, extent and progression of WMH in women with migraine and headache may be considered in risk profiling. Studies with long follow-up, starting at young age and more data about migraine frequency and attack duration are needed to investigate the sex-specific course of WMH in headache subtypes in detail.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.