Chun-Yu Cheng1,2,3; Hao-Min Cheng3,4; Shih-Pin Chen
2,3,5,6; Chih-Ping Chung2,3; Yung-Yang Lin1,2,3;
Han-Hwa Hu7,8,9; Chen-Huan Chen3,4,10,11*; Shuu-Jiun Wang1,2,3,5*
Background
The role of central pulsatile hemodynamics in the pathogenesis of white matter hyperintensities (WMHs) in migraine patients has not been clarified.
Methods
Sixty patients with migraine (20–50 years old; women, 68%) without overt vascular risk factors and 30 demographically-matched healthy controls were recruited prospectively in this prospective study. Cerebral WMHs volume was determined by T1-weighted magnetic resonance imaging with CUBE-fluid-attenuated-inversion-recovery sequences. Central systolic blood pressure (cSBP), carotid-femoral pulse wave velocity (cf-PWV), and carotid augmentation index (AI) were measured by applanation tonometry. Carotid pulsatility index (CPI) was derived from Doppler ultrasound carotid artery flow analysis.
Results
Compared to the controls, the migraine patients had a higher WMHs frequency [odds ratio (OR), 2.75; P = 0.04) and greater mean WMHs volume (0.174 vs. 0.049, cm3, P = 0.04). Multivariable regression analysis showed that WMHs volume in migraine patients was positively associated with cSBP (P = 0.04) and cf-PWV (P < 0.001), but negatively associated with CPI (P = 0.04) after controlling for potential confounding factors. The interaction effects observed indicated that the influence of cf-PWV (P = 0.004) and cSBP (P = 0.03) on WMHs formation was greater for the lower-CPI subgroup of migraine patients. WMHs volume in migraine patients increased with decreasing CPI and with increasing cSBP or cf-PWV.
Conclusions
WMHs are more common in patients with migraine than in healthy controls. Increased aortic stiffness or cSBP Central pulsatile insults in the presence of low intracranial artery resistance may predispose patients with migraine to WMHs formation.
1Institute of Brain Science, National Yang-Ming
University, Taipei, Taiwan.
2Department of Neurology, Neurological Institute,
Taipei Veterans General Hospital, Taipei, Taiwan.
3Faculty
of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
4Department of Medical Education, Taipei Veterans
General Hospital, Taipei, Taiwan.
5Brain Research Center, National Yang-Ming
University, Taipei, Taiwan.
6Institute of Clinical Medicine, National
Yang-Ming University, Taipei, Taiwan.
7Graduate Institute of Clinical Medicine, College of Medicine, Taipei
Medical University, Taipei, Taiwan.
8Cerebrovascular Treatment and Research Center, College of Medicine,
Taipei Medical University, Taipei, Taiwan.
9Department of Neurology, Taipei Medical University-Shaung Ho
Hospital, Taipei, Taiwan.
10Cardiovascular Research Center, National Yang-Ming
University, Taipei, Taiwan.
11Department of Public Health, National Yang-Ming
University, Taipei, Taiwan.
