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

다국어 초록 (Multilingual 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.

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Sachdev P, "White matter hyperintensities in midadult life" 21 : 268-274, 2008

2 Wen W, "The topography of white matter hyperintensities on brain MRI in healthy 60- to 64-year-old individuals" 22 : 144-154, 2004

3 Fazekas F, "The prevalence of cerebral damage varies with migraine type: A MRI study" 32 : 287-291, 1992

4 DeCarli C, "The effect of white matter hyperintensity volume on brain structure, cognitive performance, and cerebral metabolism of glucose in 51 healthy adults" 45 : 2077-2084, 1995

5 Vermeer SE, "Silent brain infarcts and white matter lesions increase stroke risk in the general population" 34 : 1126-1129, 203

6 Lee TK, "Prevalence of migraine in Korean adults: A national survey" 1 : 57-66, 2000

7 Rundek T, "Patent foramen ovale and migraine: a cross-sectional study from the Northern Manhattan Study (NOMAS)" 118 : 1419-1424, 2008

8 Swartz RH, "Migraine is associated with magnetic resonance imaging white matter abnormalities. A meta-analysis" 61 : 1366-1368, 2004

9 Kruit MC, "Migraine as a risk factor for subclinical brain lesions" 291 : 427-434, 2004

10 Kurth T, "Migraine and risk of cardiovascular disease in women" 296 : 283-291, 2006

11 De Benedittis G, "Magnetic resonance imaging in migraine and tension-type headache" 35 : 264-268, 1995

12 Robbins L, "MRI in migraineurs" 32 : 507-508, 1992

13 Kruit MC, "Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study" 128 : 2068-2077, 2005

14 Diener HC, "Headache classification by history has only limited predictive value for headache episodes treated in controlled trials with OTC analgesics" 29 : 188-193, 2009

15 Cooney BS, "Frequency of magnetic resonance imaging abnormalities in patients with migraine" 36 : 616-621, 1996

16 Kim JS, "Epidemiological and clinical characteristics of tension-type headache in Korea" 15 : 615-623, 1997

17 Gozke E, "Cranial magetic resonance imaging findings in patients with migraine" 44 : 166-169, 2004

18 Kruit MC, "Brain stem and cerebellar hyperintense lesions in migraine" 37 : 1109-1112, 2006