Syncope and orthostatic intolerance increase risk of brain lesions in migraineurs and controls

and the Laboratory of Epidemiology, Demography and Biometry (L.J.L.), National Institute on Aging, National Institutes of Health, Bethesda, MD.
Neurology (Impact Factor: 8.29). 04/2013; 80(21). DOI: 10.1212/WNL.0b013e318293e1c7
Source: PubMed


We and others showed that migraineurs are at increased risk of subclinical and clinical ischemic brain lesions. Migraineurs also have a higher prevalence of frequent syncope and orthostatic intolerance, symptoms that are associated with transient reductions in cerebral blood flow. In this study, we assessed whether these autonomic symptoms may contribute to the increased risk of brain lesions in migraine.

Migraineurs (n = 291) and controls (n = 140) from the population-based, cross-sectional CAMERA (Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis) cohort (aged 30-60 years, and free of other neurologic symptoms) underwent 1) brain MRI scan, and 2) structured telephone interview including questions on frequent syncope (≥5/lifetime) and orthostatic intolerance.

Frequent syncope (odds ratio [OR] = 2.7; 95% confidence interval: 1.3-5.5) and orthostatic intolerance (OR = 2.0 [1.1-3.6]) were independent risk factors for high load of deep white matter lesions. Effects were strongest in women and similar in migraineurs and controls. Migraine diagnosis did not mediate or moderate these associations. Individuals with orthostatic intolerance had higher prevalence of high periventricular white matter lesion load (OR = 1.9 [1.1-3.5]). Syncope and orthostatic intolerance were not related to subclinical infarcts or infratentorial lesions.

Frequent syncope, orthostatic intolerance, and migraine independently increase the risk of white matter lesions, particularly in females.

16 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Analgesic overuse often happens to migraine patients, especially chronic migraineurs, and migraine has been demonstrated to be associated with white matter lesions (WMLs). The aim of this study was to investigate the relationship between medication overuse headache (MOH) and WMLs in chronic migraine (CM) patients. Subjects were enrolled and divided into three groups: healthy controls, CM without MOH (CMwoMOH), and CM with MOH (CM-MOH). Most of the CM patients used non-steroidal anti-inflammatory drugs (NSAIDs) as acute headache medications. All the participants underwent magnetic resonance imaging scans and images were obtained for WML evaluation with semiquantitative scales. One hundred and forty-one participants were included, 45 of them for controls, 38 for CMwoMOH, and 58 for CM-MOH. In women, CMwoMOH patients had a higher prevalence of high WML load compared with controls and CM-MOH patients. In men, however, all the study groups showed no differences in the prevalence of high WML load. CMwoMOH women had increased risks of high deep white matter lesion (DWML) load compared with controls, while they had no risks of high periventricular white matter lesion (PVWML) load. CM-MOH women had no risks of high DWML load, but they had reduced risks of high PVWML load. The association of CM-MOH with high WML load in women was not changed when compared with CMwoMOH. Age was independently associated with high WML load among women. These data suggest that MOH caused by NSAIDs is not a risk factor for WMLs. Rather, NSAID overuse probably protects MOH patients from WMLs through anti-inflammatory effects.
    No preview · Article · Feb 2014 · Journal of Neurology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical and basic science research has revolutionized the way that we view migraine headache. Epidemiological studies have defined the demographic, comorbid conditions, and risk factors for chronic migraine. Neuroimaging studies have shown differences in cortical thickness, gray and white matter, and functional connectivity, establishing that the brains of migraine patients clearly differ from those of non-migraineurs. Genetic studies have identified new genetic loci that will help us understand the pathophysiology of migraine headache. Pharmacological infusions of nitric oxide, calcitonin gene-related peptide, and pituitary adenylate cyclase-activating polypeptide trigger delayed attacks of migraine and provide evidence that these molecules may be part of the cascade of neurobiological events that occur during a migraine attack. Monoclonal antibodies directed against CGRP or its receptor, as well as medical devices, offer promise in the abortive and preventative treatment of migraine. This chapter reviews many of the new and exciting advances in the headache field in recent years.
    No preview · Article · Dec 2015
  • Source

    Full-text · Article · Oct 2015 · Europace
Show more