Impact Factor 3.552

The 2nd most cited open-access journal in Clinical Neurology

Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2018.00080

Basilar artery lateral displacement may be associated with migraine with aura

  • 1Department of Neurology, Langone Medical Center,New York University, United States
  • 2Department of Neurology, Hospital of the University of Pennsylvania, United States

Abstract:
OBJECTIVE
To determine if structural features of the vertebrobasilar arterial system are related to migraine.
BACKGROUND
Alterations in cerebral vascular structure and function have been associated with migraine, possibly mediated by hypoperfusion and/or endothelial dysfunction triggering cortical spreading depression. Vessel tortuosity, in particular, has been associated with both altered hemodynamics and endothelial function. Symptoms of migraine with aura often localize to the occipital cortex, and evidence supports the localization of a migraine generator to the brainstem, suggesting that the vertebrobasilar system may be of particular relevance.
METHODS
We performed a post-hoc exploratory analysis of data collected in a prospective, observational, case-control study enrolling migraine with aura (MWA), migraine without aura (MwoA), and control subjects in a 1:1:1 ratio. 3T high-resolution MR angiography was used to assess vascular structure, and arterial spin labeled perfusion MRI to measure interictal cerebral blood flow (CBF). White matter lesions were assessed using T2/FLAIR. Vertebral and basilar artery (BA) diameters and BA total lateral displacement were measured.
RESULTS
162 subjects were included (52 control/52 MWA/ 58 MwoA). Mean age was 33 ± 6 years, and 78% were female. BA diameter was similar across groups (3.6 ± 0.6 mm in all 3 groups). BA displacement was similar in MwoA (5.1±3.0 mm) and controls (4.9±3.1 mm), but tended to be greater in MWA (6.3±3.8 mm, p=0.055 vs. controls). BA displacement increased with age (p<0.001) was greater in men vs. women (6.6±4.2 vs. 5.1±3.0, p=0.02) and with increased migraine frequency (p=0.03). In multivariate analysis, BA displacement was significantly greater in MWA subjects (p=0.02), with older age (p=0.003), and in men (p=0.046). In regression analysis adjusted for age and sex, BA displacement remained significantly greater with increasing migraine frequency (p=0.02). There was no association between BA displacement and interictal posterior cerebral artery territory CBF or overall white matter lesions.
CONCLUSIONS
Basilar artery lateral displacement may be associated with MWA as well as headache frequency. This association does not appear to be mediated by cerebral hypoperfusion.

Keywords: Magnetic Resonance Imaging, Migraine with Aura, Vertebrobasilar artery, Migraine, Posterior Circulation

Received: 27 Oct 2017; Accepted: 05 Feb 2018.

Edited by:

Bruce Campbell, University of Melbourne, Australia

Reviewed by:

Jan F. Scheitz, Charité Universitätsmedizin Berlin, Germany
Fana Alemseged, University of Melbourne, Australia  

Copyright: © 2018 Zhang, Cucchiara, Kasner and Detre. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Brett Cucchiara, Hospital of the University of Pennsylvania, Department of Neurology, 3400 Spruce Street, 3 W. Gates Building, Philadelphia, 19104, PA, United States, cucchiar@mail.med.upenn.edu