Episodic migraine and white matter hyperintensities: association of pain lateralization

The number of MRI studies have identified an increased prevalence of white matter hyperintensities (WMHs) in migraine patients. Although the association between migraine and WMHs has been sought, WMHs and laterality of the pain in migraine have not been studied up to now. Therefore, the results of the present study demonstrated that pain in episodic migraine is associated with the occurrence of WMHs in the cerebral hemispheres.

The pathophysiology of migraine includes a neuronal mechanism that is firmly linked with the neuronal stimulation of peripheral trigeminal nociceptive pathways. A vascular mechanism also associated with the migraine pathophysiology, sustained by studies regarding the presence of migraine with aura in many vascular diseases. Migraine is connected with silent white matter hyperintensities (WMHs) and infarct-like lesions that can be experienced during magnetic resonance imaging. This study intended to illustrate the migraine-WMH link on the basis of pain lateralization.

A total of 628 episodic migraine patients were selected and measured their cranial magnetic resonance images concerning the existence of deep, periventricular, and subcortical WMHs. The identification of lesion occurrence and pain side association was also done.

Patients found to have more subcortical/deep hyperintensities in the cerebral hemisphere that was ipsilateral to the pain side. No association was seen between periventricular hyperintensities and pain side.  

As per findings, episodic migraine pain shows associations with the WMHs presence in the cerebral hemispheres.