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Kruit MC, van Buchem MA, Hofman PAM, et al. Migraine as a Risk Factor for Subclinical Brain Lesions. JAMA. 2004;291(4):427–434. doi:10.1001/jama.291.4.427
Author Affiliations: Departments of Radiology (Drs Kruit and van Buchem) and Neurology (Drs Terwindt and Ferrari), Leiden University Medical Center, Leiden, Department of Radiology, Academic Hospital Maastricht, Maastricht (Dr Hofman), and Department of Radiology, Slingeland Hospital, Doetinchem (Dr Bakkers), the Netherlands; and Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Md (Dr Launer).
Context Clinical series have suggested an increased prevalence of cerebral infarction
and white matter lesions (WMLs) in migraine patients. It is not known whether
these lesions are prevalent in the general migraine population.
Objectives To compare the prevalence of brain infarcts and WMLs in migraine cases
and controls from the general population and to identify migraine characteristics
associated with these lesions.
Design Cross-sectional, prevalence study of population-based sample of Dutch
adults aged 30 to 60 years.
Participants Randomly selected patients with migraine with aura (n = 161), patients
with migraine without aura (n = 134), and controls (n = 140), who were frequency
matched to cases for age, sex, and place of residence. Nearly 50% of the cases
had not been previously diagnosed by a physician.
Main Outcome Measures Brain magnetic resonance images were evaluated for infarcts, by location
and vascular supply territory, and for periventricular WMLs (PVWMLs) and deep
WMLs (DWMLs). The odds ratios (ORs) and 95% confidence intervals (CIs) of
these brain lesions compared with controls were examined by migraine subtype
(with or without aura) and monthly attack frequency (<1 attack, ≥1 attack),
controlling for cardiovascular risk factors and use of vasoconstrictor migraine
agents. All participants underwent a standard neurological examination.
Results No participants reported a history of stroke or transient ischemic attack
or had relevant abnormalities at standard neurological examination. We found
no significant difference between patients with migraine and controls in overall
infarct prevalence (8.1% vs 5.0%). However, in the cerebellar region of the
posterior circulation territory, patients with migraine had a higher prevalence
of infarct than controls (5.4% vs 0.7%; P = .02;
adjusted OR, 7.1; 95% CI, 0.9-55). The adjusted OR for posterior infarct varied
by migraine subtype and attack frequency. The adjusted OR was 13.7 (95% CI,
1.7-112) for patients with migraine with aura compared with controls. In patients
with migraine with a frequency of attacks of 1 or more per month, the adjusted
OR was 9.3 (95% CI, 1.1-76). The highest risk was in patients with migraine
with aura with 1 attack or more per month (OR, 15.8; 95% CI, 1.8-140). Among
women, the risk for high DWML load (top 20th percentile of the distribution
of DWML load vs lower 80th percentile) was increased in patients with migraine
compared with controls (OR, 2.1; 95% CI, 1.0-4.1); this risk increased with
attack frequency (highest in those with ≥1 attack per month: OR, 2.6; 95%
CI, 1.2-5.7) but was similar in patients with migraine with or without aura.
In men, controls and patients with migraine did not differ in the prevalence
of DWMLs. There was no association between severity of PVWMLs and migraine,
irrespective of sex or migraine frequency or subtype.
Conclusions These population-based findings suggest that some patients with migraine
with and without aura are at increased risk for subclinical lesions in certain
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