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November 14, 2012

White Matter Hyperintensities in Migraine: Reason for Optimism

Author Affiliations

Author Affiliations: Departments of Neurology and Therapeutics and Ophthalmology, University of Texas Southwestern Medical Center, Dallas (Dr Friedman); Department of Neurology, Mayo Clinic, Scottsdale, Arizona (Dr Dodick).

JAMA. 2012;308(18):1920-1921. doi:10.1001/jama.2012.36530

An increasing body of evidence from cross-sectional population-based studies suggests that magnetic resonance imaging (MRI)–measured white matter hyperintensities in the brain are more common in people with migraine. In a meta-analysis of case-control studies, migraine was associated with an increased prevalence of white matter hyperintensities compared with absence of migraine (odds ratio [OR], 3.9; 95% CI, 2.26-6.72).1 A separate population-based study showed that the risk of supratentorial deep white matter hyperintensity was highest in women with migraine (OR, 2.1; 95% CI, 1.0-4.1), particularly among those with at least 1 migraine attack per month (OR, 2.6; 95% CI, 1.2-5.7).2 This study also demonstrated an increased prevalence of infratentorial (predominantly pontine) hyperintensities3 and posterior circulation territory infarctlike lesions in those with migraine and aura (OR, 13.7; 95% CI, 1.7-112), especially in those with at least 1 attack per month (OR, 15.8; 95% CI, 1.8-140).2 A third population-based study confirmed the association between migraine with aura and infarctlike lesions (OR, 12.4; 95% CI, 1.6-99.4, P for trend .005), but the lesions were not confined to the vascular territory of the posterior circulation.4