Microvascular brain damage in middle-aged women with a history of migraine with aura and/or ischemic stroke

Background Both patients with migraine with aura (MA) and patients with ischemic stroke have an increased risk of white matter hyperintensities (WMH) indicating structural microvascular brain damage. It is unclear whether other signs of microvascular damage are also more abundant in these patients, and whether patients with both conditions are more severely affected. Methods We included middle-aged women with a history of MA, ischemic stroke, or both, as well as age-matched female control participants without any neurological disease, from two cross-sectional MRI studies (CREW and WHISPER). We assessed WMH, enlarged perivascular spaces, cerebral microbleeds, lacunes, cortical superficial siderosis, parenchymal volume, and cortical atrophy, according to STRIVE criteria. A total small vessel disease (SVD) burden score was determined. We performed regression analyses to assess the association between a history of MA, stroke, or both, and the different MRI markers, adjusted for vascular risk factors. Results We included 207 women (mean age 51 years): 39 with MA, 67 with stroke, 62 with both MA and stroke, and 39 controls. MA was not associated with increased microvascular damage compared with controls. Stroke patients had more cerebellar WMH (OR 7.9, 95%CI 0.9–73.6), more cortical atrophy (β 0.2, 95%CI 0.0–0.4), and a lower parenchymal volume (β -16.1, 95%CI -30.7–-1.4) compared with controls. There was no difference in the frequency of any of the SVD markers on 3T-MRI in patients with stroke with or without migraine. Conclusions In our study, markers of microvascular cerebral damage were infrequent in middle-aged women with MA and healthy controls, while stroke was associated with more cerebellar WMH, decreased parenchymal volume, and cortical atrophy. We found no (supra-)additive effect of a history of migraine on the extent of microvascular brain damage in women with stroke.