Abstract Details

Title Migraine Characteristics in Patients with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (11:45 AM-12:45 PM)

Poster/Presentation
Number 14-011

Objective We systematically evaluate the clinical features and management of migraine in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in a multi-center health system.

Background Migraine is common in patients with CADASIL and may be the earliest symptom of the disease.

Design/Methods Clinical data was extracted from the electronic medical records of patients diagnosed with CADASIL and managed at Mayo Clinic Enterprise. Diagnosis was confirmed by a pathogenic NOTCH3 mutation or granular osmiophilic material on skin biopsy.

Results Seventy-five patients with CADASIL were identified. Fifty-one patients (68.0%) reported headaches, with a mean age of onset of 36.3 years (SD = 15.6). Thirty patients (40.0%) had a diagnosis of migraine with aura and ten patients (13.3%) had a diagnosis of migraine without aura. The most common type of aura was visual (83.3%). Male sex was associated with lower odds of diagnosis of migraine (OR = 0.1, 95% CI = 0.0 - 0.6, P = 0.007). Twenty-seven patients (67.5%) required at least one form of acute therapy, and twenty-three patients (57.5%) required at least one form of preventive therapy. Acute therapy helped in twenty-five cases (92.6%) and preventive therapy helped in sixteen cases (69.6%). The presence of visual aura was associated with higher odds of need for acute therapy (OR = 3.6, 95% CI = 1.9 - 6.7, P = 0.003). Also, the presence of any type of aura was associated with higher odds of response to preventive therapy (OR = 75.0, 95% CI = 3.9 - 1434.1, P = 0.004).

Conclusions More than half of patients with CADASIL had a diagnosis of migraine, most commonly female patients. Around two thirds of them tried at least one form of acute or preventive therapy. Resistance to preventive therapy was seen in around 30% of the cases, highlighting the need for advances in migraine management in CADASIL.

Authors/Disclosures
Roaa Zayat, MD PRESENTER	Dr. Zayat has nothing to disclose.
Dinith Mendis	Mr. Mendis has nothing to disclose.
Md Manjurul Islam Shourav, MBBS	Mr. Shourav has nothing to disclose.
Olga Fermo, MD (Mayo Clinic)	Dr. Fermo has received personal compensation in the range of $500-$4,999 for serving as a Author with Elsevier .
James F. Meschia, MD, FAAN (Mayo Clinic)	The institution of Dr. Meschia has received research support from NINDS. The institution of Dr. Meschia has received research support from NINDS.

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