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      Circle of Willis variations in migraine patients with ischemic stroke

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          Abstract

          Objectives

          Migraine is a risk factor for stroke, which might be explained by a higher prevalence in anatomical variants in the circle of Willis (CoW). Here, we compared the presence of CoW variants in patients with stroke with and without migraine.

          Materials and Methods

          Participants were recruited from the prospective Dutch acute Stroke Study. All participants underwent CT angiography on admission. Lifetime migraine history was assessed with a screening questionnaire and confirmed by an interview based on International Classification of Headache Disorders criteria. The CoW was assessed for incompleteness/hypoplasia (any segment <1 mm), for anterior cerebral artery asymmetry (difference > 1/3), and for posterior communicating artery (Pcom) dominance (Pcom–P1 difference > 1/3). Odds ratios with adjustments for age and sex ( aOR) were calculated with logistic regression.

          Results

          We included 646 participants with stroke, of whom 52 had a history of migraine. Of these, 45 (87%) had an incomplete or hypoplastic CoW versus 506 (85%) of the 594 participants without migraine ( aOR: 1.47; 95% CI: 0.63–3.44). There were no differences between participants with and without migraine in variations of the anterior or posterior CoW, anterior cerebral artery asymmetry ( aOR: 0.86; 95% CI: 0.43–1.74), or Pcom dominance ( aOR: 0.64; 95% CI: 0.32–1.30). There were no differences in CoW variations between migraine patients with or without aura.

          Conclusion

          We found no significant difference in the completeness of the CoW in acute stroke patients with migraine compared to those without.

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          Most cited references37

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          The International Classification of Headache Disorders: 2nd edition.

          (2004)
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            The role of spreading depression, spreading depolarization and spreading ischemia in neurological disease.

            The term spreading depolarization describes a wave in the gray matter of the central nervous system characterized by swelling of neurons, distortion of dendritic spines, a large change of the slow electrical potential and silencing of brain electrical activity (spreading depression). In the clinic, unequivocal electrophysiological evidence now exists that spreading depolarizations occur abundantly in individuals with aneurismal subarachnoid hemorrhage, delayed ischemic stroke after subarachnoid hemorrhage, malignant hemispheric stroke, spontaneous intracerebral hemorrhage or traumatic brain injury. Spreading depolarization is induced experimentally by various noxious conditions including chemicals such as potassium, glutamate, inhibitors of the sodium pump, status epilepticus, hypoxia, hypoglycemia and ischemia, but it can can also invade healthy, naive tissue. Resistance vessels respond to it with tone alterations, causing either transient hyperperfusion (physiological hemodynamic response) in healthy tissue or severe hypoperfusion (inverse hemodynamic response, or spreading ischemia) in tissue at risk for progressive damage, which contributes to lesion progression. Therapies that target spreading depolarization or the inverse hemodynamic response may potentially treat these neurological conditions.
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              Migraine headache and ischemic stroke risk: an updated meta-analysis.

              Observational studies, including recent large cohort studies that were unavailable for prior meta-analysis, have suggested an association between migraine headache and ischemic stroke. We performed an updated meta-analysis to quantitatively summarize the strength of association between migraine and ischemic stroke risk. We systematically searched electronic databases, including MEDLINE and EMBASE, through February 2009 for studies of human subjects in the English language. Study selection using a priori selection criteria, data extraction, and assessment of study quality were conducted independently by reviewer pairs using standardized forms. Twenty-one (60%) of 35 studies met the selection criteria, for a total of 622,381 participants (13 case-control, 8 cohort studies) included in the meta-analysis. The pooled adjusted odds ratio of ischemic stroke comparing migraineurs with nonmigraineurs using a random effects model was 2.30 (95% confidence interval [CI], 1.91-2.76). The pooled adjusted effect estimates for studies that reported relative risks and hazard ratios, respectively, were 2.41 (95% CI, 1.81-3.20) and 1.52 (95% CI, 0.99-2.35). The overall pooled effect estimate was 2.04 (95% CI, 1.72-2.43). Results were robust to sensitivity analyses excluding lower quality studies. Migraine is associated with increased ischemic stroke risk. These findings underscore the importance of identifying high-risk migraineurs with other modifiable stroke risk factors. Future studies of the effect of migraine treatment and modifiable risk factor reduction on stroke risk in migraineurs are warranted. Copyright 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                m.j.h.wermer@lumc.nl
                Journal
                Brain Behav
                Brain Behav
                10.1002/(ISSN)2157-9032
                BRB3
                Brain and Behavior
                John Wiley and Sons Inc. (Hoboken )
                2162-3279
                16 February 2019
                March 2019
                : 9
                : 3 ( doiID: 10.1002/brb3.2019.9.issue-3 )
                : e01223
                Affiliations
                [ 1 ] Department of Neurology Leiden University Medical Center Leiden The Netherlands
                [ 2 ] Department of Radiology Leiden University Medical Center Leiden The Netherlands
                [ 3 ] Department of Radiology University Medical Center Utrecht Utrecht The Netherlands
                [ 4 ] Department of Neurology University Medical Center Utrecht Utrecht The Netherlands
                [ 5 ] Department of Neurology VU Medical Center Amsterdam The Netherlands
                [ 6 ] Department of Neurology Antonius Hospital Nieuwegein The Netherlands
                [ 7 ] Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
                [ 8 ] The Julius Center University Medical Center Utrecht Utrecht The Netherlands
                [ 9 ] Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus University Medical Center Utrecht Utrecht The Netherlands
                Author notes
                [*] [* ] Correspondence

                Marieke Wermer, Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.

                Email: m.j.h.wermer@ 123456lumc.nl

                Author information
                https://orcid.org/0000-0003-2546-3610
                Article
                BRB31223
                10.1002/brb3.1223
                6422794
                30772952
                a577a5a2-a6cb-4f18-b469-485ea26f1190
                © 2019 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 February 2018
                : 18 December 2018
                : 22 December 2018
                Page count
                Figures: 0, Tables: 4, Pages: 8, Words: 7283
                Funding
                Funded by: Netherlands Organization for Scientific Research
                Funded by: Dutch Heart Foundation
                Award ID: 2011T055
                Award ID: 2008T034
                Funded by: Dutch Brain Foundation
                Award ID: F2014(1)‐22
                Funded by: NutsOhra Foundation
                Award ID: 0903‐012
                Categories
                Original Research
                Original Research
                Custom metadata
                2.0
                brb31223
                March 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.1 mode:remove_FC converted:18.03.2019

                Neurosciences
                circle of willis,computed tomography,humans,migraine,neuroimaging,strokes
                Neurosciences
                circle of willis, computed tomography, humans, migraine, neuroimaging, strokes

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