title: Systemic and cerebral endothelial dysfunction in chronic migraine. A case-control study with an active comparator.
abstract: OBJECTIVE
  Unlike migraine and migraine with aura, little information exists regarding chronic migraine (CM) as a risk factor for cardiovascular disease. In this study we aim to determine whether an association between CM and endothelial dysfunction exists.
  
  
  METHODS
  Individuals 18 years and older diagnosed with episodic migraine (EM) and CM according to ICHD criteria were studied. After an overnight fast and abstinence from vasoactive drugs, ultrasound studies were performed and blood samples taken from patients and matched controls according to internationally agreed on protocols.
  
  
  RESULTS
  A total of 113 individuals were enrolled (35 CM, 37 EM, 41 controls). CM patients had a lower percentage of flow-mediated vasodilation (FMD; difference of means = 5.03%; p = 1.0E-6) and breath-holding index (BHI; difference of means 0.754; p = 2.0E-6), as well as increased carotid intima media thickness (cIMT; difference of means = 0.128 mm; p = 7.0E-5) than controls. The EM patients and controls comparison found similar, but less pronounced, differences: decreased BHI (p = 0.031), and increased cIMT (p = 0.028). Fibrinogen (r = 0.277; p = 0.006), C-reactive protein (r = 0.288; p = 0.003), and erythrocyte rate sedimentation (r = 0.298; p = 0.002) also correlated with cIMT, and inversely with BHImV and FMD.
  
  
  CONCLUSIONS
  Migraine is associated with systemic and cerebral endothelial dysfunction demonstrated by ultrasound studies and biological markers. The degree of these changes was strongly associated with the severity of migraine. Our data indicate that migraine may be a cerebral disorder with systemic endothelial damage.
authors.affiliation: Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: González-Quintanilla
authors.affiliation: Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Toriello
authors.affiliation: Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Palacio
authors.affiliation: Service of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
authors.affiliation: Health Service of Camargo Costa, Servicio Cántabro de Salud, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Castillo
authors.affiliation: Health Service of Camargo Costa, Servicio Cántabro de Salud, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Montes
authors.affiliation: Health Service of Camargo Costa, Servicio Cántabro de Salud, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Martínez-Nieto
authors.affiliation: Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Fernandez
authors.affiliation: Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rojo
authors.affiliation: Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gutiérrez
authors.affiliation: Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain.
authors.forename: Enar
authors.initials: E
authors.lastname: Pons
authors.affiliation: Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain agustin.oterino@gmail.com.
authors.forename: Agustín
authors.initials: A
authors.lastname: Oterino
mesh_terms: D000293:Adolescent; D000328:Adult; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000503:physiopathology*; D014652:Vascular Diseases / Q000150:complications / Q000503:physiopathology*; D059289:Vascular Stiffness; D014664:Vasodilation; D055815:Young Adult
keywords: Migraine; cerebral vasoreactivity; chronic migraine; endothelial damage; flow-mediated dilation; intima media thickness; ultrasound study