Correlation between migraine and cerebral small vessel disease: A case–control study

Abstract Background Microcirculatory pathology is one of the pathophysiological theories of migraine, which may present as visually subclinical lesions. Image markers of cerebral small vessel disease (CSVD) have been investigated in elderly migraineurs. However, past studies looked at only part of image features, and the conclusions may have been hindered by confounding factors. The relationship between migraine and CSVD signs needs reliable demonstrations. Methods We conducted a case–control study by recruiting episodic young migraineurs from a tertiary headache centre, with tension‐type headache (TTH) and healthy controls. Distinct image features of microvascular damage and baseline characteristics across groups were assessed, and multivariate linear regression was performed to evaluate the risk factors for image abnormalities in migraineurs. Results Forty‐eight migraineurs, 32 TTHs and 49 healthy controls were included. The median age was 32 year‐old. 58.7% of the participants were female. The Scheltens score and volume of white matter hyperintensities (WMHs) in migraineurs, and the number of Virchow–Robin spaces (VRSs) in both migraineurs and TTHs were different from those in normal controls. No lacunar infarct‐like lesions (ILLs) or cerebral microbleeds (CMBs) were found. Age, education level (high level: β = −2.23, lobar WMHs), attack duration (long duration: β = 3.81, lobar WMHs) and attack frequency were independent risk factors for Scheltens score and volume of WMH in migraineurs. Migraine aura ( β = −2.389), attack frequency and education level were correlated with the number of VRSs. Conclusions Migraine was associated with WMHs and VRSs. Aura, attack duration, attack frequency, age and education level were risk factors for image abnormalities of CVSD in migraineurs. Significance This study provides a novel and comprehensive landscape of CSVD MRI features in young migraineurs, and it fills the blank of CMBs and VRSs which received less attention, with more persuasive, more reliable and stronger evidence of the association between CSVD and migraine. Our results also imply some new feature of TTH and the possible pathophysiology of the migraine course as well as new clues for the early management of migraine in terms of visual brain damage.