Association of white matter hyperintensities with migraine phenotypes and response to treatment

Sherihan Rezk Ahmed, Amr Abdel Monem Mohamed, Haitham Hamdy Salem, Shahinaz Helmy, Ramez Reda Moustafa, Sherien Mohamed Farag Borham, Sherihan Rezk Ahmed, Amr Abdel Monem Mohamed, Haitham Hamdy Salem, Shahinaz Helmy, Ramez Reda Moustafa, Sherien Mohamed Farag Borham

Abstract

Introduction: White matter hyperintensities (WMHs) are frequently found in migraineurs. However, their clinical significance and correlation to different migraine phenotypes and treatment responses are not well defined. The study aimed to examine the association of WMHs with migraine clinical patterns and treatment response.

Aim of work: We aimed to evaluate the association between WMHs and migraine phenotypes and explore the relationship of WMHs to treatment response.

Methods: Our cross-sectional study formed of 500 migraineurs who sought treatment in Kafr el-sheik university hospital and underwent (3 T) MRI to evaluate WMHs. Different migraine phenotypes were compared between patients with and without WMHs. According to reduced headache pain intensity and frequency, these patients were divided into treatment responder and non-responder groups.

Results: A total of 145 patients (29%) had WMHs. Patients with WMHs were significantly older, had a longer disease duration, and higher attack frequency. Patients who did not respond to acute and maintenance medications had a higher frequency of WMHs and high WMHs Scheltens score. Migraine with Aura and the presence of vomiting and dizziness were predictors for the development of WMHs.

Conclusion: WMHs are more common in migraine with aura. It is more frequent in migraine associated with vomiting and dizziness. WMHs increased with advancing age and more severe disease burden. Poorer response to acute and prophylactic medications was found in patients with WMHs.

Keywords: Migraine phenotypes; Migraine treatment response; WMHs.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Representative axial FLAIR images of WMHs: (A) Normal brain structures without white matter hyperintensity. (B) punctate hyperintense lesions in the both parietal lobes

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Source: PubMed

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