Occurrence of White Matter Hyperintensities in Sporadic Hemiplegic Migraine

For patients with sporadic hemiplegic migraine, white matter hyperintensities burden was higher and occurred more frequently in the parietal lobe, while lesions were larger in diameter when compared with patients with migraine headaches, according to a study published in the Journal of Neuroimaging.

The aim of this retrospective study was to assess the differences in white matter hyperintensities between patients with sporadic hemiplegic migraines and patients with migraine headaches. Basic demographics, the National Institutes of Health Stroke Scale score, functional outcomes, and magnetic resonance images were collected from a chart review.  White matter hyperintensities were classified based on location, and the degree of white matter disease was assessed using the Scheltens visual rating scale.

The patients in the sporadic hemiplegic migraine cohort (n=50) were similar for age and gender to the patients in the migraine headache cohort (n=100). For the sporadic hemiplegic migraine cohort, white matter hyperintensities were found in 56% of the patients with 48% of the patients having lesions occurring in the frontal lobe and 36% in the parietal lobe. For the migraine headache cohort, white matter hyperintensities were found in 44% of the patients with 40% of the patients having lesions occurring in the frontal lobe and 12% in the parietal lobe. Univariate analysis showed that the proportion of participants with white matter hyperintensities in the occipital, parietal lobe, and the infratentorial region was significantly higher among those with sporadic hemiplegic migraine than among those with migraine headache. In the sporadic hemiplegic migraine cohort, more patients had lesions ≥5 mm (P =.007), the mean white matter hyperintensities disease score was greater (P =.001), and the white matter hyperintensities occurring in the parietal lobe was higher (P =.043) when compared with the migraine headache cohort. Subgroup analysis indicated that white matter disease was higher in the sporadic hemiplegic migraine cohort when compared with patients who experience migraines without auras (P =.03).

Limitations of this study include the retrospective design of the study, the lack of lumbar puncture to rule out cerebrospinal fluid lymphocytosis, and lower sensitive vascular imaging modalities performed on some patients.

The researchers concluded that “white matter hyperintensities were commonly seen in the parietal lobe along with severe white matter disease in patients with sporadic hemiplegic migraine when compared [with] patients with migraine headache.”

Reference
Nagarajan E, Bollu PC, Manjamalai S, Yelam A, Qureshi AI. White matter hyperintensities in patients with sporadic hemiplegic migraine [published online July 15, 2019]. J Neuroimaging. doi: 10.1111/jon.12656