Alignment Seen Between Migraine Pain Location, White Matter Hyperintensities

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Participants were divided into left-dominant, right-dominant, and co-dominant subgroups based on white matter hyperintensities seen on MRI.
Participants were divided into left-dominant, right-dominant, and co-dominant subgroups based on white matter hyperintensities seen on MRI.

Pain experienced by patients during episodic migraine is associated with the occurrence of white matter hyperintensities (WMHs) in the cerebral hemisphere ipsilateral to the pain side, according to a new study published in Pain Medicine.

Yalcin, et al examined the presence of deep, subcortical, and periventricular WMHs found on cranial magnetic resonance images (MRI) in 628 patients with episodic migraine. They “sought to identify an association between lesion occurrence and pain side.”

The study was undertaken because migraine pathophysiology involves a neuronal mechanism that closely associated with the neuronal activation of peripheral trigeminal nociceptive pathways, as well as a vascular mechanism. Previous studies concerning the presence of migraine with aura in various vascular diseases support the concept of vascular involvement.

In addition, migraine is associated with silent infarct-like lesions and WMHs detectable on MRI. The study was designed to demonstrate the migraine-WMH link, based on pain lateralization.

The researchers found that deep/subcortical WMHs were “dominantly accumulated in the cerebral hemisphere that was ipsilateral to the pain side (ƙ =0.421) and that periventricular hyperintensities were not associated with the pain side (P=.768).

Age was associated with deep/subcortical and periventricular WMHs (r – 0.215, P <.001), while aura was only associated only with deep/subcortical WMHs.

The investigators suggested that the presence of higher lesion counts in the hemisphere ipsilateral to the pain side may be “associated with disturbances in perfusion — both increases and decreases — in the cerebral parenchyma during the pain phase.”

In light of the study findings of the mechanisms of both pain and WMH that occurred together, “it is possible that pain and development of WMH in migraine might share a common mechanism, which should be the main target of treatment options,” the investigators observed.

In this case, “a clinician might be able to both treat pain and prevent lesion accumulation in the brain,” they said.

Reference

Yalcin A, Ceylan M, Bayraktutan OF, Akkurt A. Episodic migraine and white matter hyperintensities: association of pain lateralization [published online December 8, 2017]. Pain Med. doi:10.1093/pm/pnx312

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