Reversible Cerebral Vasoconstriction Syndrome Patients with a History of Migraine: A Retrospective Case-control Study

Abstract

Objective We investigated the clinical characteristics of patients with reversible cerebral vasoconstrictor syndrome who had a history of migraine before the onset and considered the relationship between these two pathologies. Methods We investigated 98 patients who underwent magnetic resonance angiography within 14 days of the onset of reversible cerebral vasoconstriction syndrome at our hospital. Of these, 11 cases involved recurrences, so data from 87 patients were analyzed. Materials All consecutive patients diagnosed with reversible cerebral vasoconstrictor syndrome at our institution between October 2010 and July 2021. Results Fifty of the 87 patients (57%) had a history of migraine. A multivariate analysis revealed that the following clinical factors were significantly more frequent in patients with a history of migraine than in those without such a history: female sex; emotional situations as a trigger of the onset; presence of deep and subcortical white matter hyperintensity, absence of vasoconstriction in the M1 portion of the middle cerebral artery, and absence of other cerebral lesions on initial magnetic resonance imaging; absence of vasoconstriction of the basilar artery on follow-up magnetic resonance imaging; and progression of deep and subcortical white matter hyperintensity in the chronic stage. Conclusion Reversible cerebral vasoconstrictor syndrome patients with a history of migraine showed clinical features of migraine, including one aspect of cerebral small-vessel disease due to endothelial dysfunction, as a common causative condition.

Keywords: cerebral small vessel disease; migraine; reversible cerebral vasoconstriction syndrome; white matter lesion.

Figure 1.

Bar graphs show the total number of patients with reversible cerebral vasoconstrictor syndrome [with a history of migraine (black bar) and without a history of migraine (white bar)] with deep and subcortical white matter hyperintensity (DSWMH) lesions in each region.

Figure 2.

Typical findings of MRA in the RCVS patients with/without history of migraine. A) Image from a 57-year-old woman with bath-related RCVS without a history of migraine. Initial MRA obtained five days after the onset shows vasoconstriction in the right M2-3 portions (circle) and right terminal M1 portion of the MCA (white arrow) and in the right P2-3 and left P3 portions of the PCA (circle). B) Image from a 48-year-old woman with RCVS with a history of migraine. Initial MRA obtained three days after the onset shows diffuse vasoconstriction in the bilateral M2-3 portions of the MCA and P2-3 portions of the PCA (circles). However, no vasoconstriction of the major trunks of cerebral arteries, such as the M1 portion of the MCA, were found on initial MRA.

Figure 3.

Images from a 39-year-old woman with RCVS with a history of migraine. A) Initial FLAIR obtained at the time of the RCVS onset shows DSWMH (arrowhead). B) FLAIR obtained three months after the onset shows progression of DSWMH (circle).