From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea.
Neurology. 2019 Jan 22;92(4):e342-e350. doi: 10.1212/WNL.0000000000006822. Epub 2019 Jan 4.
To evaluate the association between the cerebrovascular reactivity to carbon dioxide (CO-CVR) and the deep white matter hyperintensity (WMH) burden in patients with migraine.
A total of 86 nonelderly patients with episodic migraine without vascular risk factors and 35 headache-free controls underwent 3T MRI. Deep WMHs were quantified with a segmentation method developed for nonelderly migraineurs. The interictal CO-CVR was measured with transcranial Doppler with the breath-holding method. The mean breath-holding index of the bilateral middle cerebral arteries (MCA-BHI) was square root transformed and analyzed with univariate and multivariate logistic regression models to determine its association with the highest tertiles of deep WMH burden (number and volume).
A low MCA-BHI was independently associated with the highest tertile of deep WMH number in patients with migraine (adjusted odds ratio [OR] 0.02, 95% confidence interval [CI] 0.0007-0.63, = 0.026). In controls, the MCA-BHI was not associated with deep WMH number. Interaction analysis revealed that migraine modified the effect of MCA-BHI on deep WMH number ( for interaction = 0.029). The MCA-BHI was not associated with increased deep WMH volume in both patients and controls. Age was independently associated with deep WMH volume in patients (adjusted OR 1.07, 95% CI 1.004-1.15, = 0.037).
In this study, we found a migraine-specific association between a reduced CVR to apnea and increased number of deep WMHs in healthy, nonelderly patients with migraine. A dysfunctional vascular response to apnea may predispose migraineurs to an increased risk of WMHs.
评估二氧化碳脑血管反应性（CO-CVR）与偏头痛患者深部白质高信号（WMH）负荷之间的关系。
共纳入 86 例无血管危险因素的发作性偏头痛非老年患者和 35 例无头痛对照者，行 3T MRI 检查。采用专为非老年偏头痛患者开发的分割方法对深部 WMH 进行量化。采用经颅多普勒超声屏气法测量间歇期 CO-CVR。双侧大脑中动脉（MCA）的平均屏气指数（MCA-BHI）进行平方根转换，并通过单变量和多变量逻辑回归模型进行分析，以确定其与深部 WMH 负荷（数量和体积）最高三分位数的相关性。
低 MCA-BHI 与偏头痛患者深部 WMH 数量最高三分位数独立相关（校正比值比[OR]0.02，95%置信区间[CI]0.0007-0.63， = 0.026）。在对照组中，MCA-BHI 与深部 WMH 数量无关。交互分析显示偏头痛改变了 MCA-BHI 对深部 WMH 数量的影响（ for 交互=0.029）。MCA-BHI 与患者和对照组的深部 WMH 体积增加无关。年龄是患者深部 WMH 体积的独立相关因素（校正 OR 1.07，95%CI 1.004-1.15， = 0.037）。
在这项研究中，我们发现健康、非老年偏头痛患者中，CO-CVR 对屏气的反应减弱与深部 WMH 数量增加之间存在偏头痛特异性关联。对屏气反应的血管功能障碍可能使偏头痛患者更容易发生 WMH 增加的风险。
