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Abstract Details

The Inverse Relationship Between Cerebral Microbleed Burden and Migraine-Related Disability in CADASIL
Cerebrovascular Disease and Interventional Neurology
S40 - Stroke Risk Factors and Epidemiology (4:03 PM-4:14 PM)
004
CADASIL is caused by a mutation in the NOTCH3 gene leading to progressive central nervous system small vessel disease. Patients often have coexisting migraine with aura (MA), though its relationship to the underlying CADASIL pathophysiology remains unclear.

To evaluate the relationship between cerebral microbleed (CMB) burden and migraine-related disability in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).
We performed a prospective, cross-sectional, observational study of a series of adults with CADASIL who had a brain MRI with a hemosiderin-sensitive sequence. The Microbleed Anatomical Rating Scale (MARS) was used to quantify CMB burden in which ordinal advancing score signifies greater CMB quantity. The Migraine Disability Assessment Questionnaire (MIDAS) was used to quantify migraine related disability (0-5, 6-10, 11-20, >20 meaning no, minimal, moderately limited, and severely limited disability respectively). Brain MRIs were assessed blinded to clinical data or questionnaire results.
Twenty-three CADASIL patients with and without MA were included (mean enrollment age, 59 years; 65% women). A total of 43.5% (10/23) had ≥1 on MIDAS (mean 26, range 0 to 197) and 56.5% (13/23) had ≥1 CMB (MARS range: 0 to 53). Those with ≥1 CMBs were significantly less likely to have a MIDAS ≥1 (odd ratio 0.05; 95% CI 0.01 to 0.49; P=0.01). The inverse relationship remained significant after adjusting for age at MRI scanning and MIDAS interview.
A unique inverse relationship was noted between CMB burden and migraine-related disability amongst CADASIL patients. Future investigations may serve to understand the relationship of MA phenotype on CMBs in CADASIL, the influence of the trigeminovascular system on cerebral small vessel disease and on novel therapeutic pathways to forestall small vessel disease progression in CADASIL.
Authors/Disclosures
Eric Goldstein, MD (Brown University Warren Alpert School of Medicine)
PRESENTER 		Dr. Goldstein has nothing to disclose.
No disclosure on file
James P. Klaas, MD, FAAN No disclosure on file
No disclosure on file
No disclosure on file
Robert D. Brown, Jr., MD, MPH, FAAN (Mayo Clinic) Dr. Brown has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Craig H Neilsen Foundation. The institution of Dr. Brown has received research support from National Institutes of Health/NINDS. Dr. Brown has received publishing royalties from a publication relating to health care.
David W. Dodick, MD, FAAN (Atria Institute) Dr. Dodick has received personal compensation for serving as an employee of Mayo Clinic. Dr. Dodick has received personal compensation for serving as an employee of Atria Health. Dr. Dodick has received personal compensation for serving as an employee of Thomas Jefferson University . Dr. Dodick has received personal compensation for serving as an employee of Norwegian University of Science and Technology. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Allergan. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biopharm Communications. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli Lilly. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Inside Practice Australia. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clinical 好色先生 Alliance. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Headache Cooperative of the Pacific . Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medica Communications. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MJ Healthcare. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nocira. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Praxis. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Revance . Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Synapse Medical Communications. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vector Psychometrics. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as a Consultant for Ayya Biosciences. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as a Consultant for Theranica. Dr. Dodick has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Atria. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for WebMD. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Thomas Jefferson University. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medforce. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Precision HEOR. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Canadian Headache Society. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Headache Cooperative of New England. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen Japan. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for KingDevick Technologies. Dr. Dodick has received personal compensation in the range of $1,000,000+ for serving as an officer or member of the Board of Directors for Precon Health. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Ontologics. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Matterhorn. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Axon Therapeutics. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Cephalgia Group. Dr. Dodick has stock in Healint. Dr. Dodick has stock in Theranica. Dr. Dodick has stock in Aural Analytics . Dr. Dodick has stock in Epien. Dr. Dodick has stock in Matterhorn. Dr. Dodick has stock in Ontologics. Dr. Dodick has stock in Precon Health. Dr. Dodick has stock in King Devick Technologies. Dr. Dodick has stock in Nocira. Dr. Dodick has stock in Exsano. Dr. Dodick has stock in Palion. Dr. Dodick has stock in AYYA Biosciences. Dr. Dodick has stock in Perfood. Dr. Dodick has stock in Cephalgia Group. Dr. Dodick has stock in Atria Health. Dr. Dodick has stock in Man and Science. Dr. Dodick has stock in Eigenlyfe. An immediate family member of Dr. Dodick has stock in ScotiaLyfe. Dr. Dodick has stock in Axon Therapeutics. The institution of Dr. Dodick has received research support from Department of Defense. The institution of Dr. Dodick has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Dodick has received research support from Henry Jackson Foundation. Dr. Dodick has received intellectual property interests from a discovery or technology relating to health care. Dr. Dodick has received intellectual property interests from a discovery or technology relating to health care. Dr. Dodick has received intellectual property interests from a discovery or technology relating to health care. Dr. Dodick has received publishing royalties from a publication relating to health care. Dr. Dodick has received publishing royalties from a publication relating to health care. Dr. Dodick has received publishing royalties from a publication relating to health care. Dr. Dodick has a non-compensated relationship as a Chair with American Brain Foundation that is relevant to AAN interests or activities. Dr. Dodick has a non-compensated relationship as a Committee member/Course Director with 好色先生 that is relevant to AAN interests or activities. Dr. Dodick has a non-compensated relationship as a Chair/Immediate Past Chair with American Migraine Foundation that is relevant to AAN interests or activities. Dr. Dodick has a non-compensated relationship as a Chair Global Patient Advocacy Coalition with International Headache Society that is relevant to AAN interests or activities.
Todd D. Rozen, MD, FAAN (Mayo Clinic) No disclosure on file
David J. Capobianco, MD, FAAN (Mayo Clinic) No disclosure on file
Michelle P. Lin, CRC (Mayo Clinic Florida) Dr. Lin has nothing to disclose.
Josephine F. Huang, MD Dr. Huang has nothing to disclose.
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.