Page 32 - Migraine, the heart and the brain

Chapter 2
introduCtion
Background
Migraine affects up to 15% of the general population.1-3 One-third of patients with migraine have associated symptoms of neurological aura.2,3 Previous work in the cross-sectional community-based Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis (CAMERA-1) study demonstrated a higher prevalence and greater volume of magnetic resonance imaging (MRI)-measured deep white matter hyperintensities, infratentorial hyperintensities, and posterior circulation territory infarctlike lesions in participants with migraine.4-6 A higher volume of deep white matter hyperintensities7 and increased prevalence of posterior circulation territory infarctlike lesions has also been demonstrated in women with migraine with aura8 and the prevalence of deep white matter hyperintensities was increased among patients with migraine identi ed from neurology clinics.9
White matter hyperintensities, infratentorial hyperintensities, and posterior circulation territory infarctlike lesions are believed to be of ischemic origin. In particular, white matter hyperintensities are associated with atherosclerotic disease risk factors,9 increased risk of ischemic stroke,10-12 and cognitive decline.13 The associations of migraine with these MRI-measured lesions and clinical ischemic stroke7,14 are consistent with the hypothesis that recurring migraine headaches may be associated with cerebral ischemia and that migraine-associated cerebral ischemia may be attack related. In the current study, we report associations of migraine and migraine subtype with the progression of MRI-measured cerebral ischemic lesions at the 9-year follow-up of the original CAMERA study population. In exploratory analyses, we report associations of migraine frequency, total number of migraine attacks during follow-up, and presence of current migraine headache symptoms with progression of brain lesions. In additional exploratory analyses, we determined whether progression of brain lesions was associated with cognitive decline and whether the presence of migraine headache influenced any association of brain lesion progression with cognitive decline.
30