Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

Abstract BackgroundDeep white matter hyperintensities (DWMHs), often identified by hyperintense lesions on T2-weighted magnetic resonance imaging (MRI), were discovered to have a higher prevalence in migraine patients. A right-to-left shunt (RLS), which is also prevalent in migraineurs, could potentially contribute to the formation of DWMHs by induction of controversial embolism and endothelial dysfunction. In this cross-sectional study, we aim to evaluate the association between RLS and the prevalence of DWMHs in patients with migraine.MethodsIn this study, we consecutively enrolled patients with migraine aged between 18 and 50 years from the 14 headache clinics of participating hospitals. DWMHs were rated using Scheltens scale on digital MRI images obtained from 1.5T scanners, and RLS was detected via contrast-enhanced transcranial Doppler. Analyses on DWMH prevalence and loads by RLS grading or subtype were performed. A logistic regression analysis on DWMH prevalence was also performed.ResultsIn all, 237 migraine patients (age: 39.3 ± 11.7, 78.1% women, 13% migraine with aura) were enrolled. RLS was detected in 48.5% of the subjects and DWMHs were identified in 138 (58.2%) patients. Prevalence of DWMHs did not differ significantly between RLS+ (57.4%) and RLS− patients (59.0%, p = 0.74). No statistical difference in DWMH loads was found between different RLS grades or subtypes. Instead of RLS grades (p = 0.75), age (OR 1.067; 95%CI 1.034–1.101; p < 0.001) and aura (OR 4.063; 95%CI 1.492–11.061; p = 0.006) were statistically significant independent risk factors for increased DWMH prevalence in migraine patients.ConclusionsOur findings do not support an association between RLS and DWMHs in migraine patients, regardless of RLS grades or subtypes.Clinical Trial Registration: NCT 03418766; Date of registration: February 1, 2018