Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study
MC Kruit,
MA Van Buchem, LJ Launer,
GM Terwindt,
MD Ferrari,
Corresponding Author
MC Kruit
Departments of Radiology and
Mark C Kruit MD, Department of Radiology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands. Tel. + 31-71-526-4376, fax + 31-71-524-8256, e-mail [email protected]Search for more papers by this authorLJ Launer
Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment, Bilthoven, the Netherlands, and
Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
Search for more papers by this authorGM Terwindt
Neurology, Leiden University Medical Centre, Leiden and
Search for more papers by this authorMD Ferrari
Neurology, Leiden University Medical Centre, Leiden and
Search for more papers by this authorMC Kruit,
MA Van Buchem, LJ Launer,
GM Terwindt,
MD Ferrari,
Corresponding Author
MC Kruit
Departments of Radiology and
Mark C Kruit MD, Department of Radiology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands. Tel. + 31-71-526-4376, fax + 31-71-524-8256, e-mail [email protected]Search for more papers by this authorLJ Launer
Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment, Bilthoven, the Netherlands, and
Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
Search for more papers by this authorGM Terwindt
Neurology, Leiden University Medical Centre, Leiden and
Search for more papers by this authorMD Ferrari
Neurology, Leiden University Medical Centre, Leiden and
Search for more papers by this authorAbstract
Previous studies have suggested that migraine is a risk factor for brain lesions, but methodological issues hampered drawing definite conclusions. Therefore, we initiated the magnetic resonance imaging (MRI) ‘CAMERA’ (Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis) study. We summarize our previously published results. A total of 295 migraineurs and 140 controls were randomly selected from a previously diagnosed population-based sample (n = 6039), who underwent an interview, physical examination and a brain MRI scan. Migraineurs, notably those with aura, had higher prevalence of subclinical infarcts in the posterior circulation [odds ratio (OR) 13.7; 95% confidence interval (CI) 1.7, 112]. Female migraineurs were at independent increased risk of white matter lesions (WMLs; OR 2.1; 95% CI 1.0, 4.1), and migraineurs had a higher prevalence of brainstem hyperintense lesions (4.4% vs. 0.7%, P = 0.04). We observed a higher lifetime prevalence of (frequent) syncope and orthostatic insufficiency in migraineurs; future research needs to clarify whether autonomic nervous system dysfunction could explain (part of) the increased risk of WMLs in female migraineurs. Finally, in migraineurs aged < 50 years, compared with controls, we found evidence of increased iron concentrations in putamen (P = 0.02), globus pallidus (P = 0.03) and red nucleus (P = 0.03). Higher risks in those with higher attack frequency or longer disease duration were found consistent with a causal relationship between migraine and lesions. This summary of our population-based data illustrates that migraine is associated with a significantly increased risk of brain lesions. Longitudinal studies are needed to assess whether these lesions are progressive and have relevant (long-term) functional correlates.
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Ferrari MD.
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