Highlights
- •Migraine is associated with a reduced cerebrovascular reactivity (CVR) compared to normal controls.
- •Younger age is associated with reduced CVRs of the posterior cerebral artery (PCA) in patients with migraine.
- •Younger age of onset fully explains the reduced PCA CVR in younger migraineurs.
- •Longer disease duration negatively modifies the effect of age of onset on the PCA CVR.
Abstract
Background
Previous studies reported an increased risk of ischemic stroke in younger migraineurs.
We aimed to investigate the association between age and cerebrovascular reactivity
(CVR) to vasodilatory stimuli in cerebral arteries in patients with migraine and normal
controls.
Methods
In this cross-sectional study, we recruited 248 patients with migraine and 105 normal
controls at Samsung Medical Center between October 2015 and July 2018. CVR was measured
interictally by using the transcranial Doppler breath-holding test. For the arteries
which showed a correlation between age and CVR, we conducted univariable and multivariable
linear regression analysis to assess the independent effect of age on CVR. The path
analysis was performed to assess mediating effects of the age of onset and disease
duration on the age-CVR association.
Results
Patients had reduced CVR in all tested arteries compared to normal controls. A correlation
between age and CVR was present in the posterior cerebral artery (PCA) only in patients
(Pearson's correlation coefficient = 0.160, p = 0.012). In patients, younger age was independently associated with lower CVR in
the PCA (multivariable B = 0.003, 95% CI = 0.0002–0.005, p = 0.033 adjusted for sex, migraine subtype, and headache frequencies). The path analysis
showed that the age of onset fully mediated the effect of age on PCA CVR, while longer
disease duration negatively modified the effect of age of onset (p for interaction = 0.018).
Conclusions
In migraineurs, younger age was associated with CVR reduction in the PCA. Younger
age of onset may be a hidden risk factor mediating the paradoxical association between
age and CVR. This association might explain an increased risk of stroke in younger
migraineurs.
Keywords
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Article info
Publication history
Published online: January 24, 2019
Accepted:
January 23,
2019
Received in revised form:
January 8,
2019
Received:
September 26,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
