Episodic migraine and white matter hyperintensities: Association of pain lateralization

Background. Migraine pathophysiology involves a neuronal mechanism that is closely associated with the neuronal activation of peripheral trigeminal nociceptive pathways. It also involves a vascular mechanism that is supported by studies concerning the presence of migraine with aura in various vascular diseases. Migraine is associated with silent infarct-like lesions and white matter hyperintensities (WMHs) that can be encountered during magnetic resonance imaging. In this study, we aimed to demonstrate the migraine-WMH link based on pain lateralization. Methods. We recruited 628 episodic migraine patients and examined their cranial magnetic resonance images regarding the presence of deep, subcortical, and periventricular WMHs. We sought to identify an association between lesion occurrence and pain side. Results. We found that the patients had more deep/ subcortical hyperintensities in the cerebral hemisphere that was ipsilateral to the pain side (ĸ = 0.421). Periventricular hyperintensities were not associated with the pain side (P = 0.768). Conclusions. Based on our study results, we concluded that pain in episodic migraine is associated with the occurrence of WMHs in the cerebral hemispheres. © 2017 American Academy of Pain Medicine. All rights reserved.