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White matter lesions in chronic migraine with medication overuse headache: a cross-sectional MRI study

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Abstract

Analgesic overuse often happens to migraine patients, especially chronic migraineurs, and migraine has been demonstrated to be associated with white matter lesions (WMLs). The aim of this study was to investigate the relationship between medication overuse headache (MOH) and WMLs in chronic migraine (CM) patients. Subjects were enrolled and divided into three groups: healthy controls, CM without MOH (CMwoMOH), and CM with MOH (CM-MOH). Most of the CM patients used non-steroidal anti-inflammatory drugs (NSAIDs) as acute headache medications. All the participants underwent magnetic resonance imaging scans and images were obtained for WML evaluation with semiquantitative scales. One hundred and forty-one participants were included, 45 of them for controls, 38 for CMwoMOH, and 58 for CM-MOH. In women, CMwoMOH patients had a higher prevalence of high WML load compared with controls and CM-MOH patients. In men, however, all the study groups showed no differences in the prevalence of high WML load. CMwoMOH women had increased risks of high deep white matter lesion (DWML) load compared with controls, while they had no risks of high periventricular white matter lesion (PVWML) load. CM-MOH women had no risks of high DWML load, but they had reduced risks of high PVWML load. The association of CM-MOH with high WML load in women was not changed when compared with CMwoMOH. Age was independently associated with high WML load among women. These data suggest that MOH caused by NSAIDs is not a risk factor for WMLs. Rather, NSAID overuse probably protects MOH patients from WMLs through anti-inflammatory effects.

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Acknowledgments

The WML rating was performed by Zhifeng Chen and Bing Zhang from Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University. The authors are grateful to Prof. Mark W. Massing from the Carolinas Center for Medical Excellence for his assistance in writing this manuscript. This study was supported by grants from the National Natural Science Foundation of China (Grant No. 81171101), National Key Discipline and National Key Clinical Department.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China

    Zhenyang Zheng, Zijian Xiao, Xiaolei Shi, Weiwei Qi, Aiwu Zhang & Yannan Fang

  2. Department of Rehabilitation, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China

    Minghui Ding

  3. Department of Neurology, Shaanxi Provincial People’s Hospital, No. 256 Youyi West Road, Xi’an, 710068, China

    Wei Di

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  1. Zhenyang Zheng
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  2. Zijian Xiao
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  3. Xiaolei Shi
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  4. Minghui Ding
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  5. Wei Di
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  7. Aiwu Zhang
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Corresponding authors

Correspondence to Aiwu Zhang or Yannan Fang.

Additional information

Z. Zheng and Z. Xiao contributed equally to this work.

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Zheng, Z., Xiao, Z., Shi, X. et al. White matter lesions in chronic migraine with medication overuse headache: a cross-sectional MRI study. J Neurol 261, 784–790 (2014). https://doi.org/10.1007/s00415-014-7267-1

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  • DOI: https://doi.org/10.1007/s00415-014-7267-1

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