Venous leg symptoms in patients with migraine: a potential clue on the pathophysiology of migraine (Vein-Migraine study)
Authors: Cuglan B , Onalan A , Ozturk S , Altuntas E , Demirel A B , Atmaca H , Altintas M S , Yetkin E 
Published: October 2021

Abstract

Background
Chronic venous disorders (CVD) that conventionally refers to disease of lower and upper extremity venous system encompass a large spectrum of abnormalities in the venous system. Recently, various venous disorders such as hemorrhoids, varicocele and lower extremity varicose veins have been gathered under the term of dilating venous disease (DVeD). So, vascular wall pathology itself has been supposed to be the underlying mechanism of DVeD in different vascular systems. Migraine is a neurovascular disorder which cerebral venous congestion might have role in pathogenesis. Both vascular and neurogenic theories have been postulated for the pathophysiology of migraine. We hypothesized that pathophysiology of migraine might related with DVeD due to vascular theory.

Purpose
The objective was to assess the association between venous disease and migraine by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in migraineurs and non-migraineurs.

Methods
The study was designed as a non-randomized, prospective cohort study and consisted of patients diagnosed with migraine. The control group included age- and sex-matched healthy subjects. All participants were examined for the presence of CVD. Presence of lower extremity venous system disease and subsequent classification has been assessed and categorized according to clinical component of clinical, etiological, anatomical and pathological (CEAP) classification. VEINES-Sym questionnaire was applied to assess venous symptoms. The Migraine Disability Assessment (MIDAS) questionnaire was used to assess the severity of disease in migraineurs.

Results
Participants were classified into two groups as migraine (+) group (n=130) and migraine (−) group (n=130) (Figure 1). Migraine patients and control group were comparable in terms of clinical status and demographic parameters. The mean score of night cramps, burnings, itching, tingling and throbbing were found to be lower in migraineurs than those of non-migraineurs. In addition, the presence of venous symptoms, aching legs, night cramps, heat/burning sensation, throbbing and tingling were found to be significantly higher in patients with migraine compared with those without migraine (Figure 2). Also, total VEINES-Sym score was lower in patients with migraine compared to control group (34.4±8.7, 37.6±8.12, p=0.003, respectively). Additionally, there was a significant negative correlation between VEINES-Sym score and total MIDAS disability score (r=−0.33, p&lt;0.001) and MIDAS severity levels (r=−0.266, p=0.003) of the migraineurs. Logistic regression analysis revealed that VEINES-Sym score is an independent and statistically significant associate of migraine (OR: 0.95, 95% CI: 0.92–0.98, p=0.001).

Conclusions
We have documented an independent association between migraine and VEINES-Sym score indicating possible pathophysiological link between migraine and CVD.

Funding Acknowledgement
Type of funding sources: None.