Abstract
Migraine patients with multiple brain white matter hyperintensities (WMHs) may represent a diagnostic challenge. Using double inversion recovery (DIR) imaging, we studied whether cortical lesions (CLs) could be seen in these patients. Approval of the institutional review boards and written informed consent were obtained from each participant. CLs and WM lesions were assessed on brain scans from 32 migraine patients with WMHs (17 patients with and 15 without aura), and in two control groups, consisting of 15 relapsing-remitting multiple sclerosis (RRMS) patients and 20 healthy controls, matched for age and gender. By definition, brain WM lesions were detected in all migraine and RRMS patients. The number and volume of WM lesions were lower in migraine versus RRMS patients (p < 0.0001). No CLs were identified in migraine patients and healthy controls, whereas 20 CLs were seen in 9 (60 %) RRMS patients. The application of DIR imaging to assess focal cortical involvement seems to be useful in the diagnostic workup of patients with WMHs of unknown etiology, including those with migraine.
Similar content being viewed by others
References
The Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders: 2nd edn. Cephalalgia 24(Suppl) 1:9–160
Calabrese M, Filippi M, Gallo P (2010) Cortical lesions in multiple sclerosis. Nat Rev Neurol 6:438–444
Charil A, Yousry TA, Rovaris M, Barkhof F, De Stefano N, Fazekas F, Miller DH, Montalban X, Simon JH, Polman C, Filippi M (2006) MRI and the diagnosis of multiple sclerosis: expanding the concept of “no better explanation”. Lancet Neurol 5:841–852
Cotton F, Rambaud L, Hermier M (2006) Dual inversion recovery MRI helps identifying cortical tubers in tuberous sclerosis. Epilepsia 47:1072–1073
Fazekas F, Koch M, Schmidt R, Offenbacher H, Payer F, Freidl W, Lechner H (1992) The prevalence of cerebral damage varies with migraine type: a MRI study. Headache 32:287–291
Filippi M, Rocca MA, Calabrese M, Sormani MP, Rinaldi F, Perini P, Comi G, Gallo P (2010) Intracortical lesions: relevance for new MRI diagnostic criteria for multiple sclerosis. Neurology 75:1988–1994
Geurts JJ, Roosendaal SD, Calabrese M, Ciccarelli O, Agosta F, Chard DT, Gass A, Huerga E, Moraal B, Pareto D, Rocca MA, Wattjes MP, Yousry TA, Uitdehaag BM, Barkhof F (2011) Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI. Neurology 76:418–424
Giorgio A, Stromillo ML, Rossi F, Battaglini M, Hakiki B, Portaccio E, Federico A, Amato MP, De Stefano N (2011) Cortical lesions in radiologically isolated syndrome. Neurology 77:1896–1899
Kruit M, van Buchem M, Launer L, Terwindt G, Ferrari M (2010) Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia 30:129–136
Kruit MC, Launer LJ, Ferrari MD, van Buchem MA (2005) Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study. Brain 128:2068–2077
Kruit MC, van Buchem MA, Hofman PA, Bakkers JT, Terwindt GM, Ferrari MD, Launer LJ (2004) Migraine as a risk factor for subclinical brain lesions. JAMA 291:427–434
Kruit MC, van Buchem MA, Launer LJ, Terwindt GM, Ferrari MD (2010) Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia 30:129–136
Moschiano F, D’Amico D, Di Stefano M, Rocca N, Bussone G (2007) The role of the clinician in interpreting conventional neuroimaging findings in migraine patients. Neurol Sci 28(Suppl 2):S114–S117
Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O’Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302
Porter A, Gladstone JP, Dodick DW (2005) Migraine and white matter hyperintensities. Curr Pain Headache Rep 9:289–293
Rossato G, Adami A, Thijs VN, Cerini R, Pozzi-Mucelli R, Mazzucco S, Anzola GP, Del Sette M, Dinia L, Meneghetti G, Zanferrari C (2010) Cerebral distribution of white matter lesions in migraine with aura patients. Cephalalgia 30:855–859
Rugg-Gunn FJ, Boulby PA, Symms MR, Barker GJ, Duncan JS (2006) Imaging the neocortex in epilepsy with double inversion recovery imaging. Neuroimage 31:39–50
Turetschek K, Wunderbaldinger P, Bankier AA, Zontsich T, Graf O, Mallek R, Hittmair K (1998) Double inversion recovery imaging of the brain: initial experience and comparison with fluid attenuated inversion recovery imaging. Magn Reson Imaging 16:127–135
Conflicts of interest
None of the authors has any conflct of interest in relation to the study reported in manuscript.
Ethical standard
All human studies must state that they have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Absinta, M., Rocca, M.A., Colombo, B. et al. Patients with migraine do not have MRI-visible cortical lesions. J Neurol 259, 2695–2698 (2012). https://doi.org/10.1007/s00415-012-6571-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-012-6571-x