Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Neurology. 2013 May 21;80(21):1958-65. doi: 10.1212/WNL.0b013e318293e1c7. Epub 2013 Apr 24.
We and others showed that migraineurs are at increased risk of subclinical and clinical ischemic brain lesions. Migraineurs also have a higher prevalence of frequent syncope and orthostatic intolerance, symptoms that are associated with transient reductions in cerebral blood flow. In this study, we assessed whether these autonomic symptoms may contribute to the increased risk of brain lesions in migraine.
Migraineurs (n = 291) and controls (n = 140) from the population-based, cross-sectional CAMERA (Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis) cohort (aged 30-60 years, and free of other neurologic symptoms) underwent 1) brain MRI scan, and 2) structured telephone interview including questions on frequent syncope (≥5/lifetime) and orthostatic intolerance.
Frequent syncope (odds ratio [OR] = 2.7; 95% confidence interval: 1.3-5.5) and orthostatic intolerance (OR = 2.0 [1.1-3.6]) were independent risk factors for high load of deep white matter lesions. Effects were strongest in women and similar in migraineurs and controls. Migraine diagnosis did not mediate or moderate these associations. Individuals with orthostatic intolerance had higher prevalence of high periventricular white matter lesion load (OR = 1.9 [1.1-3.5]). Syncope and orthostatic intolerance were not related to subclinical infarcts or infratentorial lesions.
Frequent syncope, orthostatic intolerance, and migraine independently increase the risk of white matter lesions, particularly in females.
我们和其他人的研究表明，偏头痛患者发生亚临床和临床缺血性脑损伤的风险增加。偏头痛患者还经常出现晕厥和体位不耐受，这些症状与短暂性脑血流减少有关。在这项研究中，我们评估了这些自主神经症状是否会导致偏头痛患者脑损伤风险增加。
来自基于人群的横断面 CAMERA（偏头痛中的脑异常，一项流行病学风险分析）队列的偏头痛患者（n=291）和对照组（n=140）（年龄 30-60 岁，无其他神经系统症状）接受了 1）脑部 MRI 扫描，和 2）包括频繁晕厥（≥5/终生）和体位不耐受问题的结构化电话访谈。
频繁晕厥（比值比[OR] = 2.7；95%置信区间：1.3-5.5）和体位不耐受（OR = 2.0 [1.1-3.6]）是深部白质病变高负荷的独立危险因素。这些影响在女性中最强，在偏头痛患者和对照组中相似。偏头痛诊断不能介导或调节这些关联。体位不耐受者发生高脑室周围白质病变负荷的比例更高（OR = 1.9 [1.1-3.5]）。晕厥和体位不耐受与无症状性梗死或幕下病变无关。
频繁晕厥、体位不耐受和偏头痛独立增加了脑白质病变的风险，尤其是在女性中。
