뇌혈관위험인자가 없는 젊은 두통 환자의 백색질 이상: 편두통과 긴장형두통
White Matter Abnormalities of Migraine and Tension Type Headache in Young Patients Without Vascular Risk Factors
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Background: White-matter abnormalities (WMAs) are frequently encountered on MRI conducted for the diagnosis of headache. Although many studies have suggested an association between migraine and stroke or WMAs, no definite conclusions can be drawn from these data because of confounding factors. The purpose of our study was thus to determine whether the incidence and location of WMAs in migraine differ from those in tension-type headache. Methods: The MRI findings of 180 patients (130 with migraine and 50 with tension-type headache) under 45 years of age without vascular risk factors were reviewed. MRI findings were reviewed with respect to focal white-matter hyperintensities on fluid-attenuated inversion recovery. The frequency, location, and volume of the abnormalities were measured. Results: WMAs were observed in 24% of patients with migraine and 28% of those with tension-type headache (p=0.71). The number and volume of abnormalities in both groups were not different. WMAs were most frequently located in the subcortical area in both groups. The age of patients with WMAs was older than patients without abnormalities (36.4±7.2 vs 29.6±9.2, mean±SD; p<0.01). There was a positive correlation between patient age and the volume of WMAs (p=0.04). In the migraine group, WMAs were seen in 21% of patients with migraine without aura and in 60% of those with migraine with aura (p=0.01). Conclusions: Although the characteristics of WMAs were not different between patients with migraine and those with tension-type headache, the incidence of WMAs was significantly higher in migraine with aura. This may be extrapolated to an increased risk for stroke in patients with migraine with aura, but not in those with migraine without aura.
Abstract
Background: White-matter abnormalities (WMAs) are frequently encountered on MRI conducted for the diagnosis of headache. Although many studies have suggested an association between migraine and stroke or WMAs, no definite conclusions can be drawn from these data because of confounding factors. The purpose of our study was thus to determine whether the incidence and location of WMAs in migraine differ from those in tension-type headache. Methods: The MRI findings of 180 patients (130 with migraine and 50 with tension-type headache) under 45 years of age without vascular risk factors were reviewed. MRI findings were reviewed with respect to focal white-matter hyperintensities on fluid-attenuated inversion recovery. The frequency, location, and volume of the abnormalities were measured. Results: WMAs were observed in 24% of patients with migraine and 28% of those with tension-type headache (p=0.71). The number and volume of abnormalities in both groups were not different. WMAs were most frequently located in the subcortical area in both groups. The age of patients with WMAs was older than patients without abnormalities (36.4±7.2 vs 29.6±9.2, mean±SD; p<0.01). There was a positive correlation between patient age and the volume of WMAs (p=0.04). In the migraine group, WMAs were seen in 21% of patients with migraine without aura and in 60% of those with migraine with aura (p=0.01). Conclusions: Although the characteristics of WMAs were not different between patients with migraine and those with tension-type headache, the incidence of WMAs was significantly higher in migraine with aura. This may be extrapolated to an increased risk for stroke in patients with migraine with aura, but not in those with migraine without aura.
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