Migraine with aura and risk of silent brain infarcts and white matter hyperintensities: an MRI study

Abstract

A small number of population-based studies reported an association between migraine with aura and risk of silent brain infarcts and white matter hyperintensities in females. We investigated these relations in a population-based sample of female twins. We contacted female twins ages 30-60 years identified through the population-based Danish Twin Registry. Based on questionnaire responses, twins were invited to participate in a telephone-based interview conducted by physicians. Headache diagnoses were established according to the International Headache Society criteria. Cases with migraine with aura, their co-twins, and unrelated migraine-free twins (controls) were invited to a brain magnetic resonance imaging scan performed at a single centre. Brain scans were assessed for the presence of infarcts, and white matter hyperintensities (visual rating scales and volumetric analyses) blinded to headache diagnoses. Comparisons were based on 172 cases, 34 co-twins, and 139 control subjects. Compared with control subjects, cases did not differ with regard to frequency of silent brain infarcts (four cases versus one control), periventricular white matter hyperintensity scores [adjusted mean difference (95% confidence interval): -0.1 (-0.5 to 0.2)] or deep white matter hyperintensity scores [adjusted mean difference (95% confidence interval): 0.1 (-0.8 to 1.1)] assessed by Scheltens' scale. Cases had a slightly higher total white matter hyperintensity volume compared with controls [adjusted mean difference (95% confidence interval): 0.17 (-0.08 to 0.41) cm(3)] and a similar difference was present in analyses restricted to twin pairs discordant for migraine with aura [adjusted mean difference 0.21 (-0.20 to 0.63)], but these differences did not reach statistical significance. We found no evidence of an association between silent brain infarcts, white matter hyperintensities, and migraine with aura.

Keywords: cerebral infarction; cerebral ischaemia; headache: imaging; migraine; migraine with aura.

Migraine with aura is considered a putative risk factor for silent brain infarcts and white matter hyperintensities in women. In an MRI study of Danish female twins aged 30–60 years, Gaist et al. compare 172 affected women with 139 controls, but find no evidence to support the proposed associations.

Figure 1

Flow-chart of recruitment and participation in Women with Migraine with Aura Neuroimaging (WOMAN) study. CVD = cerebrovascular disorder; MA = migraine with aura. ^a No migraine in twin or co-twin. ^b Includes 20 case-case twin pairs.

Figure 2

White matter hyperintensity scores assessed by visual rating scales in 172 females with migraine with aura (cases) and 139 migraine-free female control subjects .

Figure 3

Individual within-pair differences in WMH scores assessed by visual rating scales in 34 female twin pairs discordant for migraine with aura. Each slot on the x -axis represents an individual twin pair.