Click here for an explanation of these scores
Answer Rating key
|
search
|
|
strong
|
|
appraisal
|
|
weak
|
|
confidence
|
|
moderate
|
Question answered:19/02/08
A 2004 meta-analysis in Archives of Neurology [1] concludes:
“This meta-analysis demonstrates that subjects with migraine are at higher risk of having WMAs on magnetic resonance images than those without migraine. This increased risk is present even in younger individuals who do not have co-occurring cerebrovascular disease risk factors. Prospective studies are needed to determine whether the increased risk of stroke in migraine is mediated or foreshadowed by the presence of WMAs.”
In the discussion they report:
“The presence of MRI WMA may reflect pathologic conditions other than ischemia, such as demyelinating disease, CADASIL, or other connective tissue disease. The studies reviewed in the present analysis did not report the volume or number of white matter changes, but in most migraine-related WMA the changes are multiple, small, deep white matter or small and periventricular in location. Extensive periventricular abnormalities or large lacunar infarcts in the deep white matter or deep gray matter nuclei should increase suspicion for other processes (eg, CADASIL or small-vessel disease, respectively). Therefore, careful clinical correlation would be required before ascribing the observed WMA to migraine. Other investigations such as cerebrospinal fluid analysis or appropriate serologic tests may be indicated and should be ascertained on a case-by-case basis.”
eMedicine, in their chapter on migraine variants [2], report:
“Additionally, migraine, predominantly migraine with aura, is associated with the presence of silent infarctions or white matter changes on brain MRI.”
A recent (2007) review has the following abstract [3]:
“Changes in cerebral white matter at CT or MRI have been reported in patients with migraine, especially in those with migraine with aura. Similar pictures may be present in asymptomatic subjects, and their nature is not completely understood, but their infarct-like nature is strongly suggested. Clinicians play an important role in the evaluation of those migraine patients in whom these nonspecific abnormalities are present. We suggest ruling out specific syndromes in which migraine attacks are associated with white matter changes (CADASIL, MELAS, multiple sclerosis and central nervous system vasculitis), as well as evaluating the presence of different vascular risk factors (genetic prothrombotic factors, patent foramen ovale, use of oral contraceptives, etc.). Their possible causative role in MRI lesions and in enhancing the risk of a negative clinical evolution must be considered in each individual case.”
References
1) http://archneur.ama-assn.org/cgi/content/full/61/9/1366
2) http://www.emedicine.com/NEURO/topic219.htm
3) http://www.ncbi.nlm.nih.gov/pubmed/17508156
DISCLAIMER: TRIPanswers is a collection of clinical questions and answers. Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review. If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document. Also, ensure you have read the terms and conditions for using the site.