| Sandy L 2005-04-19, 10:35 am |
| <rh551@yahoo.com> wrote in message
news:1113604098.310944.317590@f14g2000cwb.googlegroups.com...
Dr. Mark C. Kruit, from Leiden university Medical Center in the
Netherlands, and colleagues compared the number of brain lesions in 161
patients with migraine with aura, 134 with migraine without aura, and
140 similar subjects without migraine. Aura are illusions involving
sight or other senses that can accompany the headache.
The January 28, 2004, issue of the Journal of the American Medical
Association (JAMA) included an article that captured the attention of
the media and generated reports all over the Internet. The article,
"Migraine as a Risk Factor for Subclinical Brain Lesions,"? reported
on a study conducted in the Netherlands.
Some of the findings:
A total of 60 brain infarcts were detected in 31 study participants.
Proportionately more Migraineurs had at least one infarct compared with
controls. "However, in the cerebellar region of the posterior
circulation territory (PCT), patients with Migraine had a higher
prevalence of infarct than controls [5.4 percent vs. 0.7 percent; more
than seven times the risk],"
The risk of posterior circulation territory infarcts was 7.1 times
higher in the Migraineurs than the control patients.
Migraine with aura was associated with significantly increased PCT
infarcts, but not Migraine without aura.
"The adjusted OR was 13.7 (95% CI, 1.7-112) for patients with migraine
with aura compared with controls. In patients with migraine with a
frequency of attacks of 1 or more per month, the adjusted OR was 9.3
(95% CI, 1.1-76). The highest risk was in patients with migraine with
aura with 1 attack or more per month (OR, 15.8;95%CI, 1.8-140)."?
Among women, compared with controls, Migrainuers had a significantly
increased risk of high DWML (dense white matter lesion) load... that
was similar for patients with migraine without aura... and patients
with migraine with aura...This risk increased with increasing attack
frequency...; compared with controls, female migraine patients with
fewer than 1 attack per month had an OR (odds ratio) of 1.6 (95% CI,
0.8-3.5) and those with 1 or more attack per month had an OR of 2.6
(95% CI, 1.2-5.7)."?
The group with migraine with aura and 1 or more attack per month had
the highest risk of PCT infarct.
Notable comments from the authors:
"These results suggest that patients with migraine from the general
population are at increased risk of subclinical cerebellar PCT infarcts
and that the risk increases with increasing attack frequency. Patients
with migraine with aura and a high attack frequency are at greatest
risk. In addition, women, but not men, with migraine with and without
aura are at increased risk of high DWML (dense white matter lesion)
load, and this risk also increases with increasing attack
frequency."?
"Our study confirms the vulnerability of the PCT, especially for the
cerebellum in migraine patients with aura."?
"Several hemodynamic features of migraine may contribute to the
pathogenesis of both WMLs and infarcts in migraine. Repeated or
prolonged reduced perfusion pressure, reduced blood flow, and oligemia
in large and/or small arteries, combined with activation of the
clotting system or vasoconstriction, possibly mediated or induced by
endothelium perturbation (endothelin 1) could lead to arterial or
venous (micro) embolism, thrombosis, or ischemia. Dehydration during
migraine attacks might contribute to formation of local thromboses. It
is also possible that local changes during migraine attacks, such as
excessive neuronal activation, neurogenic inflammation, neuropeptide
and cytokine release, or excitotoxity, directly lead to tissue damage.
Cardiac abnormalities, such as patent foramen ovale or mitral valve
prolapse, might also increase the risk of ischemic brain changes in
patients with migraine."?
links:
http://www.w-h-a.org/wha2/Newsite/r...ContentNews=672
http://www.eurekalert.org/pub_relea...j-spw012104.php
http://emeryneuro.com/migraines_may...ain_lesions.htm
http://my.webmd.com/content/Article...m?printing=true
http://pubs.ama-assn.org/media/2004j/0127.dtl
Another research that contradicts the above research though less
published:
Frequency of Magnetic Resonance Imaging Abnormalities in Patients With
Migraine
Brian S. Cooney, Robert I. Grossman, Roger E. Farber, James E. Goin and
Steven L. Galetta
Background. The frequency of magnetic resonance imaging (MRI)
abnormalities in patients with migraine has been reported at 12% to
46%. We examined a series of patients to determine the frequency of MRI
abnormalities, and any relationship of frequency with patient age, sex,
migraine type, duration of symptoms, and other medical conditions.
Methods. Magnetic resonance imaging findings were reviewed
retrospectively with respect to presence of focal white matter
hyperintensities in 185 consecutive patients. Patients had been
diagnosed with migraine by a neurologist. All images had been
interpreted by a neuroradiologist. Clinical information was obtained by
chart review.
Results. Sixteen percent had focal white matter abnormalities. Among
patients less than 50 years old, and without other medical problems
such as hypertension, atherosclerotic heart disease, diabetes mellitus,
autoimmune disorder or demyelinating disease, only 6% had white matter
abnormalities. Increased frequency of white matter abnormalities was
associated with age and medical risk factors, but not with sex,
migraine subtype, or duration of migraine symptoms.
Conclusion. The observed frequency of MRI abnormalities in our series
is lower than has been previously reported. In many cases, these
abnormalities may be unrelated to migraine. When such changes are
discovered in a patient with migraine, other etiologies should be
considered.
link:
http://www.ahsnet.org/journal/archive/nov96abs.php
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I think Kruit et all should follow up with their research with correct
procedure and publish the results showing no change in white matter
lesions with migraine sufferers and controls.
This may tie in with the earlier information on patent foramen ovale. The
risk of PFO was higher in migraineurs with aura, and was associated with
multiple small infarcts. It might (perhaps) be worthwhile for a person:
1. who has migraine with aura and
2. who has multiple small infarcts on MRI
to get a sonocardiogram, looking for a PFO.
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