Page 93 - Migraine, the heart and the brain

To analyze the effect of AR in MFS patients on the prevalence of different migraine types, and to be able to make necessary adjustments for age and gender, a multinomial logistic regression model was used. As expected female gender was a risk factor for both migraine with and without aura (Table 3). AR was a risk factor for migraine with aura (OR 3.1 [1.2–8.0]) but not for migraine without aura. Independent from AR, MFS was not signi cantly associated with migraine with aura.
As AR was the driver in the increased prevalence of migraine with aura, Table 4 shows migraine characteristics between the study groups strati ed for AR. None of these migraine characteristics differed. In all but one of the MFS patients with migraine, onset of migraine was before AR. MFS patients without AR but with dilatation not yet requiring AR had no increased risk for migraine with aura.
Of only 41/123 (33%) of MFS patients the presence or absence of dural ectasias was known by spinal imaging. Migraine with aura was found in 24% of patients with dural ectasias compared to 13% of those without dural ectasias (OR 2.2 [0.2–21.1]).
disCussion 5
In the present, largest ever, study on the association between migraine and MFS patients we con rmed earlier reports from two smaller cohorts (10,11) that MFS is associated with an increased lifetime migraine prevalence both compared to contemporary and historical controls (1,17). Thanks to the large number of participants, we could in addition determine that MFS only increased the risk of migraine with aura and not of migraine without aura. Moreover, we showed that aorta root pathology requiring AR was, independently from MFS, associated with an increased risk of migraine with aura, whereas MFS, independently from AR, was not signi cantly associated with migraine with aura. History of an AR thus was the main driver in the increased prevalence of migraine with aura. The underlying mechanism for this association is unknown but seems to point at systemic vessel wall pathology. Further research is warranted to unveil potential mechanisms.
There is increasing evidence that migraine is linked with impaired systemic endovascular function. Migraine has been associated with diseases considered to be related to extracellular matrix disorder like cervical artery dissection (18,19). The activity of elastases, enzymes capable of degrading elastic bres and regulating enzymes of the extracellular matrix, has been associated with migraine with aura. A higher level of extracellular matrix degradation can explain both dissection as well as
Marfan syndrome and migraine
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