Distinct Vascular Profile in Middle-Aged Migraineurs: Higher Pulse Wave Velocity, Putaminal Etat Crible and Incomplete Posterior Circle of Willis.

Background: Migraineurs may develop stroke and cardiovascular diseases (CVD). We evaluated vascular findings in middle-aged migraineurs without CVD risks. Methods: Migraine was diagnosed according to ICHD-3 by direct interview and neurological examination. Migraine was classified into migraine with aura (MA) and migraine without aura (MO). Frequency of migraine attacks were denoted as < 1 /mo or ≥ 1 /mo. Severity of migraine was scaled by Headache Impact Test-6. Usual CVD risk factors of smoking, obesity, hypertension, diabetes mellitus and dyslipidemia were examined. Brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) were measured using a plethysmography. Brain magnetic resonance imaging (MRI) and angiography (MRA) were performed. Circle of Willis (CW) on MRA was morphologically classified into 2 types: complete posterior CW defined as the presence of both posterior communicating arteries and both P1 segments of posterior cerebral arteries, and other patterns of incomplete posterior CW (Ikeda et al. Headache 2007). Results: A total of 317 migraineurs (235 women and 82 men) were diagnosed. Thirty patients with CVD risk factors were excluded, and the study was completed in 287 migraineurs (215 women and 72 men), MA (n=56) and MO (n=231). Mean age (SD) was 44.0 (9.3) years. Consecutive 300 age- and sex-matched controls without migraine and CVD risks were prepared during the study. Compared to controls, baPWV was increased in migraineurs (P<0.05) and MA patients (P<0.01). ABI did not differ between migraineurs and controls. Other clinical findings of migraineurs were not linked to baPWV and ABI. MRI disclosed higher frequency of putaminal état criblé in migraineurs (P<0.05) and MA patients (P<0.01) compared to controls. Three MA patients were diagnosed with hereditary cerebral angiopathy of CADASIL (n=1), Moyamoya disease (n=1) and cavernous angioma (n=1). Morphological CW studies lower frequency of complete posterior CW in migraineurs (P<0.05) and MA patients (P<0.01) compared to controls. Conclusion: The present study suggested vascular changes of baPWV, putaminal état criblé and CW shape in migraineurs, especially in MA sufferers. The distinct vascular profile could contribute to higher risk of stroke and CVD in migraineurs.