The Relationship Between the Circle of Willis Variations and White Matter Hyperintensities in Different Migraine Subtypes

Öz

It is known that the Circle of Willis (CoW) variations and white matter hyperintensities (WMHs) are common in migraine. This retrospective study aims to investigate the relationship between the CoW variations and WMHs in migraine without aura (MWoA) (n=38) and migraine with aura (MWA) (n=40) patients. Demographic, clinical and radiological findings (the CoW variations and WMH burden) of the patients were recorded, and the relationship between the variables was evaluated in both groups. The overall incomplete COW, incomplete anterior or vertebrobasilar portion of the CoW, or the presence of fetal PCA showed no significant difference between the MWoA and MWA groups (p > 0.05). An incomplete posterior portion of the CoW was significantly higher in the MWA group than in the MWoA group (p = 0.034). In the MWA group, the visual aura was present in 72% of patients with the overall incomplete CoW; all of these were posterior portion variations of the CoW. When the WMH burden was compared, no significant difference was seen between the MWoA and MWA groups (p > 0.05). Among patients with the CoW variations in the MWoA group, the rate of patients without WMHs was significantly higher (p = 0.030). No significant difference was observed between the variations and WMH burden in the MWA group (p > 0.05). According to our study results, variations in the posterior portion of the CoW are common in MWA, and while this variation is associated with visual aura, it was found to be unrelated to WMH burden.

Anahtar Kelimeler

• Migraine with aura
• Migraine without aura
• Circle of Willis

Farklı Migren Alt Tiplerinde Willis Poligonu Varyasyonları ve Beyaz Cevher Lezyonları Arasındaki İlişki

Öz

Migrende Willis Poligonu varyasyonlarının ve beyaz cevher lezyonlarının sık gözlendiği bilinmektedir. Bu retrospektif çalışma aurasız migren (n=38) ve auralı migren (n=40) hastalarında Willis Poligonu varyasyonları ile beyaz cevher hiperintensiteleri arasındaki ilişkiyi araştırmayı amaçlamıştır. Hastaların demografik, klinik ve radyolojik bulguları (Willis Poligonu varyasyonları ve beyaz cevher hiperintensite yükleri) kaydedildi ve değişkenler arasındaki ilişki her iki grupta değerlendirildi. Herhangi bir Willis Poligon varyasyonu varlığı, Willis Poligonu’nun anterior ya da vertebrobaziler kısmında varyasyon olması veya fetal PCA varlığı aurasız migren ve auralı migren grupları arasında anlamlı fark göstermedi (p > 0.05). Willis Poligonu’nun posterior kısmında varyasyon varlığı auralı migren grubunda aurasız migren grubuna göre anlamlı derecede yüksek bulundu (p=0,034). Auralı migren grubunda, herhangi bir Willis Poligon varyasyonuna sahip hastaların %72'sinde görsel aura mevcuttu ve bu varyasyonların tümü Willis Poligonu’nun posterior kısım varyasyonlarıydı. Aurasız ve auralı migren gruplarında beyaz cevher lezyon yükü karşılaştırıldığında, gruplar arasında anlamlı farklılık görülmedi (p > 0,05). Aurasız migren grubunda, Willis Poligonu varyasyonuna sahip olan hastalar arasında beyaz cevher lezyonu olmayan hastaların oranı anlamlı olarak daha yüksekti (p = 0,030). Auralı migren grubunda, Willis Poligon varyasyonları ile beyaz cevher lezyon yükü arasında anlamlı bir fark gözlenmedi (p > 0,05). Çalışma sonuçlarımıza göre auralı migrende Willis Poligonu’nun posterior kısım varyasyonları sık görülmüştür ve bu varyasyon görsel aura ile ilişkili, beyaz cevher lezyon yükü ile ilişkisiz bulunmuştur.

Anahtar Kelimeler

• Auralı migren
• Aurasız migren
• Willis Poligonu

Kaynakça

1. 1. Ashina M, Terwindt GM, Al-Karagholi MA-M, de Boer I, Lee MJ, Hay DL, et al. Migraine: disease characterisation, biomarkers, and precision medicine. Lancet 2021;397:1496–504.
2. 2. Lipton RB, Bigal ME. Migraine: epidemiology, impact, and risk factors for progression. Headache 2005;45 Suppl 1:S3–13.
3. 3. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1–211.
4. 4. Kincses ZT, Veréb D, Faragó P, Tóth E, Kocsis K, Kincses B, et al. Are Migraine With and Without Aura Really Different Entities? Front Neurol 2019;10.
5. 5. Vgontzas A, Burch R. Episodic Migraine With and Without Aura: Key Differences and Implications for Pathophysiology, Management, and Assessing Risks. Curr Pain Headache Rep 2018;22:78.
6. 6. Hamming AM, van Walderveen MAA, Mulder IA, van der Schaaf IC, Kappelle LJ, Velthuis BK, et al. Circle of Willis variations in migraine patients with ischemic stroke. Brain Behav 2019;9:e01223.
7. 7. Cucchiara B, Wolf RL, Nagae L, Zhang Q, Kasner S, Datta R, et al. Migraine with aura is associated with an incomplete circle of willis: results of a prospective observational study. PLoS One 2013;8:e71007.
8. 8. Bugnicourt J-M, Garcia P-Y, Peltier J, Bonnaire B, Picard C, Godefroy O. Incomplete posterior circle of willis: a risk factor for migraine? Headache 2009;49:879–86.

9. 9. Dobrynina LA, Suslina AD, Gubanova MV, Belopasova AV, Sergeeva AN, Evers S, et al. White matter hyperintensity in different migraine subtypes. Sci Rep 2021;11:10881.
10. 10. Ertaş M, Siva A, Dalkara T, Uzuner N, Dora B, Inan L, et al. Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire. Headache 2004;44:786–93.
11. 11. Aurora SK, Wilkinson F. The brain is hyperexcitable in migraine. Cephalalgia 2007;27:1442–53.
12. 12. Olesen J, Friberg L, Olsen TS, Andersen AR, Lassen NA, Hansen PE, et al. Ischaemia-induced (symptomatic) migraine attacks may be more frequent than migraine-induced ischaemic insults. Brain 1993;116 ( Pt 1):187–202.
13. 13. Krabbe-Hartkamp MJ, van der Grond J, de Leeuw FE, de Groot JC, Algra A, Hillen B, et al. Circle of Willis: morphologic variation on three-dimensional time-of-flight MR angiograms. Radiology 1998;207:103–11.
14. 14. Ezzatian-Ahar S, Amin FM, Obaid HG, Arngrim N, Hougaard A, Larsson HBW, et al. Migraine without aura is not associated with incomplete circle of Willis: a case-control study using high-resolution magnetic resonance angiography. J Headache Pain 2014;15:27.
15. 15. Eikermann-Haerter K, Huang SY. White Matter Lesions in Migraine. Am J Pathol 2021;191:1955–62.
16. 16. Hadjikhani N, Sanchez Del Rio M, Wu O, Schwartz D, Bakker D, Fischl B, et al. Mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proc Natl Acad Sci U S A 2001;98:4687–92.
17. 17. Cucchiara B, Detre J. Migraine and circle of Willis anomalies. Med Hypotheses 2008;70:860–5.
18. 18. Kruit MC, van Buchem MA, Hofman PAM, Bakkers JTN, Terwindt GM, Ferrari MD, et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004;291:427–34.
19. 19. van der Grond J, van Raamt AF, van der Graaf Y, Mali WPTM, Bisschops RHC. A fetal circle of Willis is associated with a decreased deep white matter lesion load. Neurology 2004;63:1452–6.
20. 20. Cavestro C, Richetta L, L’episcopo MR, Pedemonte E, Duca S, Di Pietrantonj C. Anatomical variants of the circle of willis and brain lesions in migraineurs. Can J Neurol Sci 2011;38:494–9.