title: Syncope and orthostatic intolerance increase risk of brain lesions in migraineurs and controls.
abstract: OBJECTIVE
  We and others showed that migraineurs are at increased risk of subclinical and clinical ischemic brain lesions. Migraineurs also have a higher prevalence of frequent syncope and orthostatic intolerance, symptoms that are associated with transient reductions in cerebral blood flow. In this study, we assessed whether these autonomic symptoms may contribute to the increased risk of brain lesions in migraine.
  
  
  METHODS
  Migraineurs (n = 291) and controls (n = 140) from the population-based, cross-sectional CAMERA (Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis) cohort (aged 30-60 years, and free of other neurologic symptoms) underwent 1) brain MRI scan, and 2) structured telephone interview including questions on frequent syncope (≥5/lifetime) and orthostatic intolerance.
  
  
  RESULTS
  Frequent syncope (odds ratio [OR] = 2.7; 95% confidence interval: 1.3-5.5) and orthostatic intolerance (OR = 2.0 [1.1-3.6]) were independent risk factors for high load of deep white matter lesions. Effects were strongest in women and similar in migraineurs and controls. Migraine diagnosis did not mediate or moderate these associations. Individuals with orthostatic intolerance had higher prevalence of high periventricular white matter lesion load (OR = 1.9 [1.1-3.5]). Syncope and orthostatic intolerance were not related to subclinical infarcts or infratentorial lesions.
  
  
  CONCLUSIONS
  Frequent syncope, orthostatic intolerance, and migraine independently increase the risk of white matter lesions, particularly in females.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. m.c.kruit@lumc.nl
authors.forename: Mark C
authors.initials: MC
authors.lastname: Kruit
authors.forename: Roland D
authors.initials: RD
authors.lastname: Thijs
authors.forename: Michel D
authors.initials: MD
authors.lastname: Ferrari
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.forename: J Gert
authors.initials: JG
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D054971:Orthostatic Intolerance / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D011159:Population Surveillance / Q000379:methods*; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology