The role of magnetic resonance imaging in evaluating migraine and the relationship between Corona and migraine cases

doi:10.21203/rs.3.rs-4983479/v1

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The role of magnetic resonance imaging in evaluating migraine and the relationship between Corona and migraine cases

https://doi.org/10.21203/rs.3.rs-4983479/v1

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Introduction: Magnetic resonance imaging is indicated in case of suspected posterior fossa lesions or cerebrospinal fluid leakage. This study aims to study the symptoms and radiological signs of migraine on MRI.

Methods and materials: A retrospective study was conducted on a group of patients visiting Al-Mouwasat Hospital with a history of headache in the period from 2021 to 2024. All patients underwent MRI as an investigation due to suspicion of migraine, totaling 1561 patients.

Results: The location of the headache was found to be the frontal lobe 83%, the temporal lobe 32%, around the orbits 42%, the parietal lobe 20%, the occipital lobe 14%, and the cervical lobe 17%. Speaking about the continuation of migraine attacks for days, we found that the percentage of those who have daily migraines is 13%, those who have more than 4 months 18%, 4–8 months 26%, and 4–7 months 27%. Speaking about the cases in which radiological investigation is indicated, we found that the percentage of patients who have continued and prolonged the prodromal stage is 15%, the percentage of patients who have prolonged and severe clinical symptoms is 20%, the percentage of those who have the first appearance of migraine symptoms is 15%, the percentage of migraine without prodromes that required radiological investigation is 27%, the percentage of those who have migraine with loss of consciousness is 8%, the percentage of those who have complications is 5%, and those who have prodromes without Headache 10%, and speaking of the signs observed by MRI in migraine patients, we found that high-signal foci in the second time and the FLIR time were observed at a high rate of 92%.

Conclusion: MRI is a suitable radiological method for evaluating migraine and can be used as an indicator for treatment and monitoring chronic cases.

Neurobiology of Disease

Migraine

MRI

Covid-19

Evaluation

Migraine is a type of headache characterized by recurring attacks of moderate to severe throbbing pain on one side of the head. The pain is caused by activation of nerve fibers within the walls of blood vessels in the brain that travel within the meninges (three layers of membranes that protect the brain and spinal cord). [1–4], Untreated attacks last from four to 72 hours. Other common symptoms include: Increased sensitivity to light, noise, and smells, Nausea, Vomiting, Routine physical activity, movement, or even coughing or sneezing can make headache pain worse, Migraine attacks most often occur in the morning, especially upon waking. Some people have migraines at predictable times, such as before their period or on weekends after a stressful work week. Many people feel tired or weak after a migraine, but they are usually asymptomatic between attacks, A number of different factors may increase your risk of developing migraines. These factors, which lead to headaches, vary from one person to another and include: Sudden changes in weather or environment, Too much or too little sleep, Strong odors or fumes, Emotion, Stress, Excessive fatigue, Loud or sudden noise, Motion sickness, Low blood sugar.

Methods and Materials: Migraine has now become a hot topic among headaches and is included in the World Health Organization's list of the ten most debilitating diseases. There is now a shift in attention towards the physiological and pathological basis of this headache as well as new treatments. Magnetic resonance imaging is indicated in cases of suspected posterior fossa lesions or cerebrospinal fluid leakage. This study aims to study the symptoms and radiological signs of migraine on the MRI device. A retrospective study was conducted on a group of patients visiting Al-Mouwasat Hospital with a history of headache in Fara from 2021 to 2024. All patients underwent MRI images as an investigation due to suspicion of migraine, totaling 1561 patients, male and female.

Inclusion criteria: Clinically diagnosed migraine patients at Al-Mouwasat University Hospital who were studied clinically and radiologically.

Exclusion criteria: Migraine patients who were not followed up radiologically and patients with multiple sclerosis, migraine white matter infarction, brain tumors, lupus erythematosus, vitamin B12 deficiency.

Statistical analysis: The forms that were developed specifically for this research were filled out in a manner consistent with the data in the records. The data were entered into the Excel program and the statistical data were analyzed using the Spss-26 program, where a descriptive analysis was conducted through frequencies and percentages of qualitative variables, and quantitative variables were studied through Measures of dispersion and central tendency were used, and the Chi-Score test was performed, and the P value was considered statistically significant when it was less than 0.05.

The percentage of males was 30%, the percentage of females was 60%, and the percentage of children was 10%. We found that 60% of the patients had the AURA prodrome stage, which lasts from 5–6 minutes, while 40% had migraines without prodrome. Speaking of the symptoms in the patients, we found that the percentage of seeing flashing lights and lines was 27%, the percentage of having wavy light lines was 22%, the percentage of having an inability to tolerate loud sounds was 35%, the percentage of being unable to tolerate light was 35%, the percentage of nausea and vomiting was 27%, the percentage of severe headache was 20%, and the percentage of headaches lasting 2–72 hours was 35%. Speaking of the month in which the cases were referred to the hospital, we found that the percentage of those who referred to the hospital in March was 13%, in April 20%, in January 15%, in February 13%, and in the remaining months 39%. When studying the relationship between risk factors and migraines in pregnant women, we found that the percentage of migraine type 13%, the percentage of previous contraceptive use 35%, the relationship of migraine with weather changes 33%, the relationship of migraine with increased physical activity of the body 44%, the relationship of migraine with certain foods according to the patient’s description 15%, the relationship of migraine and its incitement with alcohol 17%, the relationship of migraine with moving to other places 25%, the relationship of migraine with smoking 13%, and when talking about the location of the headache, we found that the frontal lobe 83%, the temporal lobe 32%, around the orbits 42%, the parietal lobe 20%, the occipital lobe 14%, and the cervical lobe 17%, and when talking about the continuation of migraine attacks for days, we found that the percentage of those who continue migraine on a daily basis is 13%, and those who continue it for more than 4 months 18%, 4–8 months 26%, and 4–7 months 27%, and when talking about the cases in which radiological investigation is indicated, we found the percentage of the presence of continuation The prodromal stage was prolonged in 15% of patients, the percentage of patients with prolongation and severe increase in clinical symptoms was 20%, the percentage of those with the first appearance of migraine symptoms was 15%, the percentage of migraine without prodromes and required radiological investigation was 27%, the percentage of those with migraine with loss of consciousness was 8%, the percentage of those with complications was 5%, and those with prodromes without headache was 10%. Speaking of the signs observed by MRI in migraine patients, we found that high-signal foci in the second time and the FLIR time were seen at a high rate of 92%, but they are non-descriptive foci as the diagnosis is confused with multiple sclerosis, migraine white matter infarction, brain tumors, lupus erythematosus, vitamin B12 deficiency. The number of patients infected with Covid-19 was 311 patients, and the study showed by MRI in the second time a number of distinctive findings that did not appear in cases of migraine without Covid: Speaking of the signs observed by MRI in the second time, we found that the migraine foci were located in The cerebral cortex was found in 33% of cases, thalamus involvement with high-signal foci was found in 35%, paracentral lobe involvement was 20%, and scattered lesions were 12%. Speaking of the features of migraine compared to Covid-19, we found that the cortex (gray area) was affected by 30%, the gray matter volume decreased by 35%, and the clear lesions in the frontal area and around the orbits were 35%. By studying patients according to spectral resonance imaging, we found that the percentage of decrease in NAA in the cerebellum in migraine patients was 80%, and the percentage of NAA decrease in the thalamus in chronic migraine cases was 66%.

A study was conducted on a sample size of 1561 patients, 60% of the sample were females while only 10% of the sample were children. The clinical description of the condition was studied, where 60% of the sample recorded the presence of the prodromal stage which lasts for 5–6 minutes, while 40% of them had migraine with prodromes. 27% of the sample recorded that they see flashing lights, while 35% had headaches that lasted for 2–72 hours, 35% could not tolerate loud noises, and 20% of the sample suffer from severe headaches. In a study of the relationship between the severity of headaches and the months of the year, 20% of the sample recorded that the headaches become severe in April, and 13% have severe headaches in March (spring). Migraine headaches were also studied in pregnant women. 35% of pregnant women who suffer from headaches confirmed a history of taking oral contraceptives, while 44% confirmed that their migraines are related to physical activity, while 17% of them indicated that their migraines are triggered by alcohol, and 25% of them are related to moving to new places. 83% of the eye had a frontal headache, while 42% had it around the orbits, and 14% of the sample suffered from an occipital headache. Regarding the duration of migraine attacks, 13% had them daily, while 26% had them for 4–8 months, 18% for more than 4 months, while chronic migraine that lasts for more than 3 months was observed in 47% of the sample. We note that the previous statistics and results according to our study conducted at Al-Mowasat Hospital are consistent with a study conducted by (Olesent) and his group in 2016 and published in Cephelalgy magazine. The percentage mentioned in our study is consistent with the EMHA Migraine Association. As for brain radiological investigations, cases in which brain imaging is indicated were studied: 20% in the case of prolonged and increased clinical symptoms, 27% for migraine without symptoms, 15% in the case of persistent and prolonged symptoms. Regarding the signs observed in magnetic resonance imaging, we note that high-signal foci in the second time are observed in a high percentage of 92% of cases. Regarding patients suffering from migraine and infected with Covid, the number of patients was 311 patients, as the results of the magnetic resonance imaging showed different results for them: 33% of patients had a migraine focus in the cerebral cortex, while 35% of them had high-signal foci in the thalamus, while 12% had scattered infections. Regarding the distinction between migraine and Covid, the gray area infection in migraine occurred in 30% of patients, in addition to a decrease in the volume of gray matter in 35%, and the infection in the frontal area and around the orbits in 35% of the sample. In terms of the results of the spectral resonance imaging, 80% had a decrease in the NAA substance in the cerebellum. We note that the results of the study are consistent with the study of 2 Gerirte in 2021, published in the journal Neuroimagin, which focused on the sensitivity of glutamine metabolites GABA, which is a metabolite in the cerebral cortex, and we were unable to compare as the device does not provide GABA measurement in Al-Mowasat Hospital.

In the face of every stubborn and chronic headache, it is necessary to conduct radiological investigations in search of causative lesions such as migraine. In all cases of atypical migraine, it is preferable to conduct a CT study and resort to MRI for other cases. MRI is a suitable radiological method for evaluating migraine and can be used as an indicator for treatment and monitoring chronic cases.

Ethical approval:

Ethical approval was obtained from the hospital's systematic review board.

Consent for publication:

Not applicable.

Availability of data and materials:

All data produced in the present work are contained in the manuscript

Conflict of interest:

The authors declare that they have no Conflict of interest:

Funding:

This research received no specie grant from ASPU or any other funding agency in the public, commercial or nonprofit sectors.

Acknowledgments:

We are thankful to the management of AL-Sham Private University for their support in the eld of medical training and research. We would also like to thank Dr. Khalid Khattab for his help and supervision in the paper.

Cutrer FM (2006) Pathophysiology of migraine. Semin Neurol 26:171
Ashina M, Migraine (2020) N Engl J Med 383:1866
Charles A (2009) Advances in the basic and clinical science of migraine. Ann Neurol 65:491
Charles A (2013) Vasodilation out of the picture as a cause of migraine headache. Lancet Neurol 12:419

The authors declare potential competing interests as follows: Ethical approval was obtained from the hospital's systematic review board.

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The role of magnetic resonance imaging in evaluating migraine and the relationship between Corona and migraine cases

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Abstract

Introduction

Methods and materials

Results

Discussion

Conclusion

Declarations

References

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