Basilar artery curvature is associated with migraine with aura in the Northern Manhattan Study
Introduction
Accumulating evidence suggests a genetic link between migraine pathogenesis and vascular-related pathways. From 37 identified probable causal genes of migraine, the majority of their functional pathways are related to circulatory system development, artery development, and artery morphogenesis [1]. Structurally, migraine may be associated with cerebrovascular abnormalities including an incomplete Circle of Willis [2], white matter changes [3], and infarct-like lesions [4]. Alterations in vascular morphology may therefore play a role migraine and might also modulate the known association between ischemic stroke risk and migraine [5]. Investigators have also proposed endothelial dysfunction, microemboli, and neurometabolic imbalances as potential mechanisms for triggering cortical spreading depression (CSD) in migrainous aura, providing additional possible mechanisms linking migraine and stroke [[6], [7], [8]].
Migraine likely results from the interplay among different parts of the brain, including the occipital cortex in visual aura symptoms, the brainstem in autonomic dysfunction, and the pons in migraine generation [9]. Further, many imaging studies show increased prevalence of posterior circulation hyperintensities and infarct-like lesions [4,10]. Given possible predisposition to abnormalities in the posterior circulation territory, the vertebrobasilar system is of particular interest. In the majority of normal individuals, the basilar artery (BA) courses straight in the midline or paramedian position [11]. Anatomic deviations and vessel curvature in the vertebrobasilar system convey important influences on vertebrobasilar hemodynamics which may have implications in atherosclerosis and plaque formation [12]. Both BA dolichoectasia (abnormal elongation and dilation) and tortuosity (abnormal twists and turns) can be pathologic entities and have been linked to ischemic stroke [13,14]. Therefore, BA curvature, which refers to any BA course that deviates from midline, may also share a relationship with migraine pathophysiology. Investigators previously showed in a post-hoc analysis of the Anatomy and Cerebral Hemodynamic Evaluation of Migraine (ACHE-M) study that basilar artery curvature may be associated with MA [15]. To further investigate a potential relationship between basilar artery structure and migraine, we sought to compare basilar artery lateral displacement between migraine without aura (MwoA), MA, and migraine-free subjects among stroke-free participants from the Northern Manhattan Study (NOMAS), a large, urban, multi-ethnic prospective population-based study. We hypothesized that increased basilar artery curvature measured by lateral displacement is associated with MA.
Section snippets
Methods
This study included subjects from NOMAS, which is an ongoing, prospective, population-based study of stroke incidence and vascular risk factors in an urban, multi-ethnic population based in the Northern Manhattan area [16]. In brief, NOMAS used random digit dialing with dual-frame sampling to enroll 3298 clinically stroke-free participants who had resided in the Northern Manhattan area for at least 3 months with a telephone. In 2003, standardized MRI protocols were introduced in NOMAS and
Sample characteristics
This cross-sectional study included a sub-sample from NOMAS of 880 participants who had brain MRA and BA lateral displacement measurements, of whom 178 (20.2%) had any type of migraine. There were 146 participants (82.0% of all migraines) who had MwoA and 32 (18.0% of all migraines) who had MA. Compared to those not included who did not have BA lateral displacement measurements, the included subsample had similar age (70.7 vs 70.5 years), race-ethnicity (white: 13.9 vs 16.6%, black: 17.9 vs
Discussion
In this sample from NOMAS, we found that increased BA curvature, measured by lateral displacement throughout the course of the BA, was associated with MA. Our results showed that for every millimeter of lateral basilar artery displacement, there was a 4% greater odds of MA. The ACHE-M study previously showed in a post-hoc case-control analysis that BA displacement was associated with MA in a young cohort (average age in third decade of life) [15]. The present study from NOMAS adds to the
Sources of funding
NOMAS is funded by the National Institutes of Neurologic Disorders and Stroke, Grant #R37 NS029993. Dr. Yang was funded by the National Institutes of Neurologic Disorders and Stroke, Grant #T32NS007153-38.
Disclosures
None.
References (37)
- et al.
Microembolism of single cortical arterioles can induce spreading depression and ischemic injury; a potential trigger for migraine and related MRI lesions
Brain Res.
(2018) - et al.
Basilar artery bending length, vascular risk factors, and pontine infarction
J. Neurol. Sci.
(2014) - et al.
Basilar artery lateral displacement may be associated with migraine with aura
Front. Neurol.
(2018) - et al.
Migraine: epidemiology and systems of care
Lancet
(2021) - et al.
Migraine and the trigeminovascular system-40 years and counting
Lancet Neurol.
(2019) - et al.
Targeting calcitonin gene-related peptide: a new era in migraine therapy
Lancet
(2019) - et al.
Vertebrobasilar ectasia in patients with lacunar stroke: the secondary prevention of small subcortical strokes trial
J. Stroke Cerebrovasc. Dis.
(2015) - et al.
Problems and pitfalls of 3-d tof magnetic resonance angiography of the intracranial circulation
Clin. Radiol.
(1995) - et al.
Migrainomics – identifying brain and genetic markers of migraine
Nat. Rev. Neurol.
(2017) - et al.
Migraine with aura is associated with an incomplete circle of willis: results of a prospective observational study
PLoS One
(2013)
Migraine and structural changes in the brain: a systematic review and meta-analysis
Neurology.
Migraine headache in middle age and late-life brain infarcts
JAMA.
Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies
Neurol. Sci.
The role of endothelin in the pathophysiology of migraine – a systematic review
Curr. Pain Headache Rep.
Simultaneous monitoring of potassium, glucose and lactate during spreading depolarization in the injured human brain – proof of principle of a novel real-time neurochemical analysis system, continuous online microdialysis
J. Cereb. Blood Flow Metab.
The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks
Brain.
Brain stem and cerebellar hyperintense lesions in migraine
Stroke.
High-resolution computed tomography of the basilar artery: 1. Normal size and position
AJNR Am. J. Neuroradiol.
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