Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Seoul National University College of Medicine, Seoul, South Korea.
J Cereb Blood Flow Metab. 2022 Oct;42(10):1879-1889. doi: 10.1177/0271678X221103006. Epub 2022 May 24.
Several studies suggested the association of migraine with deep white matter hyperintensities (WMHs). We aimed to explore the cerebrovascular reactivity (CVR), deep WMH burden, and their association in patients with migraine using a state-of-the-art methodology. A total of 31 patients with migraine without aura and 31 age/sex-matched controls underwent 3T MRI with prospective end-tidal carbon dioxide (CO) targeting. We quantified deep WMH clusters using an automated segmentation tool and measured voxel-wise CVR by changes in blood oxygen level-dependent signal fitted to subjects' end-tidal CO. The association of migraine and CVR with the presence of WMH in each voxel and interaction of migraine and CVR on WMH were analysed. Patients had a higher number of deep WMHs than controls (p = 0.015). Migraine and reduced CVR were associated with increased probability of having WMHs in each voxel (adjusted OR 30.78 [95% CI 1.89-500.53], p = 0.016 and adjusted OR 0.30 [0.29-0.32], p < 0.001, respectively). Migraine had an effect modification on CVR on deep WMHs (p for interaction <0.001): i.e. the association between CVR and WMH was greater in patients than in controls. We suggest that the migraine-WMH association can be explained by the effect modification on the CVR.
几项研究表明偏头痛与深部脑白质高信号（WMH）有关。我们旨在使用最先进的方法学来探索偏头痛患者的脑血管反应性（CVR）、深部 WMH 负担及其相关性。共有 31 名无先兆偏头痛患者和 31 名年龄/性别匹配的对照者接受了 3T MRI 检查，采用前瞻性的呼气末二氧化碳（CO）靶向技术。我们使用自动分割工具来量化深部 WMH 簇，并通过拟合受试者的呼气末 CO 的血氧水平依赖信号来测量每个体素的 CVR。分析偏头痛和 CVR 与每个体素 WMH 的存在的相关性，以及偏头痛和 CVR 对 WMH 的交互作用。与对照组相比，患者的深部 WMH 数量更多（p=0.015）。偏头痛和 CVR 降低与每个体素出现 WMH 的可能性增加有关（调整后的 OR 为 30.78[95%CI 1.89-500.53]，p=0.016 和调整后的 OR 为 0.30[0.29-0.32]，p<0.001）。偏头痛对深部 WMH 的 CVR 有影响修饰作用（交互作用的 p<0.001）：即 CVR 与 WMH 之间的关联在患者中比在对照组中更强。我们认为偏头痛与 WMH 的关联可以用 CVR 的影响修饰来解释。
