Brain stem and cerebellar hyperintense lesions in migraine

Background and Purpose - Migraineurs are at increased risk of cerebellar infarcts and supratentorial white matter lesions. The prevalence, frequency, and distribution of infratentorial hyperintense lesions in migraine are unknown. Methods - Migraineurs with aura ( n = 161), without aura ( n = 134), and controls ( n = 140) from a population-based sample of adults ( 30 to 60 years of age) were evaluated with MRI. Results - Infratentorial hyperintensities were identified in 13 of 295 (4.4%) migraineurs and in 1 of 140 (0.7%) controls ( P = 0.04). Twelve cases had hyperintensities, mostly bilaterally, in the dorsal basis pontis. Those with infratentorial hyperintensities also had supratentorial white matter lesions more often. Conclusion - We found an increased prevalence of infratentorial ( mostly pontine) hyperintensities in migraineurs from the general population. This extends the knowledge about vulnerable brain regions and type of lesions in migraine brains. A hemodynamic ischemic pathogenesis is likely, but further research is needed.