Brain white matter hyperintensities in migraine: Clinical and radiological correlates.
ABSTRACT OBJECTIVE: Migraine is a recognised cause of brain white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI). However radiological characteristics of those in migraine are not well defined. We sought to study the radiological characteristics and factors associated with WMH in migraine. METHODS: Migraine patients who were investigated with MRI of the brain in the outpatient clinic were studied retrospectively. Two groups were delineated based on the presence or absence of WMH in MRI scans. The clinical and demographic characteristics between the two groups were compared to delineate the associations of WMH. RESULTS: Forty four patients were studied, out of which 19 demonstrated WMH on MRI. Frontal lobe was involved in all subjects with WMH. Infratentorial hyperintensities were not seen in any. Subcortical and deep white matter was the commonest distribution while callosal and subcallosal lesions were very rare. Family history of migraine, increasing age, and increasing headache frequency emerged as significant associations of WMH in multivariable analysis. CONCLUSIONS: There are characteristic radiological features and clinical associations of WMH in migraine.
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ABSTRACT: Migraine is characterised by debilitating pain, which affects the quality of life in affected patients in both the western and the eastern worlds. The purpose of this article is to give a detailed outline of the pathophysiology of migraine pain, which is one of the most confounding pathologies among pain disorders in clinical conditions. We critically evaluate the scientific basis of various theories concerning migraine pathophysiology, and draw insights from brain imaging approaches that have unraveled the prevalence of cortical spreading depression (CSD) in migraine. The findings supporting the role of CSD as a physiological substrate in clinical pain are discussed. We also give an exhaustive overview of brain imaging approaches that have been employed to solve the genesis of migraine pain, and its possible links to the brainstem, the neocortex, genetic endophenotypes, and pathogenetic factors (such as dopaminergic hypersensitivity). Furthermore, a roadmap is proposed to provide a better understanding of pain pathophysiology in migraine, to enable the development of strategies using leads from brain imaging studies for the identification of early biomarkers, efficient prognosis, and treatment planning, which eventually may help in alleviating some of the devastating impact of pain morbidity in patients afflicted with migraine.European Journal of Neuroscience 09/2013; · 3.75 Impact Factor
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ABSTRACT: Evaluation of focal white matter hyperintensities on magnetic resonance imaging in any age group is always challenging because the cause of these hyperintensities varies extensively. Understanding the clinical presentation, pathophysiology, and associated imaging findings can allow the radiologist to limit the differential diagnosis. A specific imaging approach including age, pattern of distribution, signal characteristics on various sequences, enhancement pattern, and other ancillary findings helps to identify a correct cause for these hyperintensities. This article provides a pattern approach to differentiate various common and a few uncommon diseases presenting as focal white matter hyperintensities.Radiologic Clinics of North America 03/2014; 52(2):241-261. · 1.95 Impact Factor