Migraine and circle of Willis anomalies

Department of Neurology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, United States.
Medical Hypotheses (Impact Factor: 1.07). 02/2008; 70(4):860-5. DOI: 10.1016/j.mehy.2007.05.057
Source: PubMed


Several mechanisms are currently thought to contribute to migraine pathogenesis, including interictal neuronal hyperexcitability, cortical spreading depression underlying the symptom of aura, and trigeminal nerve activation at a peripheral and central level. However, these mechanistic concepts incompletely explain migraine susceptibility in individual patients and do not fully account for the well documented association between migraine and ischemic cerebrovascular disease, including increased risk of both clinical stroke and subclinical brain lesions in migraine patients.

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Available from: Brett L Cucchiara,
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    • "Hypoplasticity or absence of P1 segment or PCoA has been reported in about 15–22 % of individuals with morphological variations in their CoW (Eftekhar et al. 2006; Papantchev et al. 2007). While patients with one of these CoW variations do not become ill under normal circumstances (with the exception that these variations might trigger migraines; Bugnicourt et al. 2009; Cucchiara and Detre 2008), it has been reported that reduced blood flow, due to hypoplasticity of PCoA with accompanying pathologies (e.g., ICA occlusion), could lead to health risks, including ischemic stroke (Schomer et al. 1994). Additionally, the effects of ACA diameter and other collateral abilities of the CoW with ICA occlusion have been investigated (Cassot et al. 1995; Hendrikse et al. 2001; Rutgers et al. 2000; Tanaka et al. 2006; van Raamt et al. 2006). "
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    ABSTRACT: Although cerebral blood flow is the crucial factor for cerebral infarction and the circle of Willis (CoW) is considered the primary control structure for cerebral hemodynamics, risk of cerebral infarction caused by the morphological variation in the CoW has never been studied due to lack of proper tools. Here, the alteration of cerebral blood flow in CoW variation was quantitatively assessed by a new analysis method using a microfluidic device that was controlled by pneumatic valves. Using this device, the occlusion of diverse major arteries was realized by closing the channel with pneumatic valves. The morphological variations of the CoW and their hemodynamics were designed and analyzed after occlusion of the major arteries. While the differences in hemodynamics of CoW variants were not statistically significant compared with a complete CoW without occlusion or with occlusion of the efferent arteries, the occlusion of afferent arteries such as common carotid artery and vertebral artery severely affected the flow rate (28.4–48.8 %) and related arterial pressure of efferent arteries (48.6 ± 6.7–36.0 ± 1.4 mmHg) in CoW variants where the posterior communicating artery and the P1 segment are absent, which is associated with cerebral ischemic infarction. The novel analysis system using microfluidics provides a robust and accurate method, in which the hemodynamics of individual morphological variation and stenosis, and occlusion of vessels can be analyzed. Thus, this method is particularly suitable for personalized analysis of hemodynamics and may find new applications in biomedical researches.
    Microfluidics and Nanofluidics 11/2014; 17(5). DOI:10.1007/s10404-014-1366-2 · 2.53 Impact Factor
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    • "It seems that cerebral infarcts preferentially affect posterior circulation [4,5]. The presence of the circle of Willis anomalies may contribute to decrease of cerebral blood flow in response to cortical spreading depression [6]. The circle of Willis is an important source of collateral blood flow to maintain adequate cerebral perfusion, in particular the posterior. "
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    ABSTRACT: Background The circle of Willis is an important source of collateral blood flow to maintain adequate cerebral perfusion, particularly in the posterior circulation. Some studies report a relationship between incomplete circle of Willis and migraine, whereas other studies show no difference between the prevalence of incomplete circle of Willis in migraineurs and controls. In the present study we compared the prevalence of incomplete circle of Willis in female migraine patients without aura to female healthy non-migraine controls. Using 3-Tesla magnetic resonance angiography we recorded three-dimensional time-of-flight angiograms in 85 female participants (48 migraine patients without aura [median age 28 years] and 37 healthy controls [median age 25 years]). The images were subsequently analysed blindly by a neuroradiologist to detect incomplete circle of Willis. Findings We found no difference between the prevalence of incomplete circle of Willis in patients, 20/47 (43%), and controls, 15/37 (41%), p = 0.252. Post hoc analysis showed a significant relationship between age and prevalence of incomplete circle of Willis, p = 0.003. Conclusion We found no relationship between migraine without aura and incomplete circle of Willis.
    The Journal of Headache and Pain 05/2014; 15(1):27. DOI:10.1186/1129-2377-15-27 · 2.80 Impact Factor
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    • "The most common anatomic variation in the group without vascular-related abnormalities was the absence or hypoplasia of the posterior communicating artery (Malamateniou et al., 2009). Dysregulation of cerebral blood flow may allow relative ischemia to develop in the setting of increased metabolic demand related to neuronal hyper excitability, may trigger cortical spreading depression, and may predispose individuals to ischemic lesions and stroke (Cucchiara and Detre, 2008). The study of Sahni et al. (2007) was conducted on brains of 280 adults and 45 children. "

    Forensic Medicine - From Old Problems to New Challenges, 09/2011; , ISBN: 978-953-307-262-3
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