Prevalence of headache in patients with sporadic cerebral small vessel disease

Abstract

Uvod: Bolest malih krvnih sudova (BMKS) mozga je čest nalaz kod pacijenata sa klasičnim vaskularnim faktorima rizika i povezana je sa motornim, kognitivnim i afektivnim poremećajima. Neuroradiološki, BMKS mozga se manifestuje lakunarnim infarktima i/ ili hiperintenzitetima bele mase (HBM), a moguća je i pojava mikrokrvarenja. Pored retkih naslednih oblika BMKS mozga, pacijenti sa glavoboljom, posebno migrenskog tipa, nalaze se u povećanom riziku za nastanak ovih lezija, mada je povezanost kompleksna i nedovoljno razjašnjena. Cilj: Cilj rada je identifikacija učestalosti i tipa glavobolja kod pacijenata sa sporadičnom BMKS mozga. Materijal i metode: Retrospektivnom studijom obuhvaćeno je 115 pacijenata sa dijagnozom BMKS mozga, lečenih i ispitivanih hospitalno na Odeljenju za cerebrovaskularne bolesti i rezistentne glavobolje Klinike za neurologiju Kliničkog centra Srbije, u periodu od 1. januara 2015. godine do 31. decembra 2017. godine. Analizirani su osnovni demografski podaci, tip glavobolje i nalaz na nuklearnoj magnetnoj rezonanci (NMR) mozga (prisustvo lakunarnih ishemija, HBM i ukupna težina lezija) standardnim statističkim testovima. Rezultati: Od ukupnog broja pacijenata uključenih u studiju, 44% je patilo od glavobolje. Lakunarni infarkti su uočeni kod 86,1% pacijenata, a HBM kod 46,1% pacijenta. Povezanost glavobolje i prisustva lakunarnih ishemija je bila na nivou statističkog trenda (p = 0,072), dok su pacijenti bez glavobolje imali tendenciju češće pojave HBM u odnosu na one sa glavoboljom (p = 0,065). Zaključak: Veliki broj pacijenata sa sporadičnom, arterioloskleroznom BMKS mozga se ujedno žali na glavobolju. Na NMR snimcima mozga prisustvo lakunarnih infarkta je vezano sa glavobolju kao simptom, a postojanje HBM je češće kod pacijenata bez glavobolje u anamnezi.

Introduction: Cerebral small vessel disease (CSVD), a common finding in patients with vascular risk factors, is associated with motor, cognitive and affective disorders. Magnetic resonance imaging (MRI) brain scans of patients with CSVD include lacunar infarcts and/or white matter hyperintensities (WMH) and microhemorrhages. Aside from rare familiar forms of CSVD, patients with headaches, especially migraineurs, have an increased risk to develop these lesions, although this relationship is rather complex and yet to be fully elucidated. Aim: The aim of the study was to determine the frequency and type of headache in patients with CSVD. Material and methods: This retrospective study included 115 patients with CSVD diagnosis admitted at the Clinic of Neurology, Clinical Center of Serbia in the period January 1st, 2015 - December 31st, 2017. Baseline demographic data, headache type and MRI findings (ischemic lacunar infarctions, WMH, and overall lesion severity) were obtained. Data were compared between CSVD patients with headache and headache-free CSVD cases, with the use of standard statistical methods. Results: Among all patients included in this study, 44% had headaches. Lacunar infarcts were present in 86,1% and WMH in 46,1% cases. Correlation between headache symptoms and lacunar infarcts showed a trend towards statistical significance (p = 0.072) whereas headache-free patients more frequently had WMH, also approaching statistical significance (p = 0.065). Conclusion: A large number of arteriolosclerotic CSVD patients complain of different types of headaches. Based on MRI findings, lacunar infarcts are related to headache symptoms, and WMHs are more frequently present in patients with a negative history of headache.