Basilar artery curvature is associated with migraine with aura in the Northern Manhattan Study

Introduction: Genetic and imaging studies demonstrate a link between vascular morphology and migraine with aura (MA). We examined the relationship between basilar artery (BA) curvature and MA in a population-based cohort of stroke-free participants. Methods: This cross-sectional study included participants from the MRI substudy of the Northern Manhattan Study. Participants had structured migraine assessments at enrollment and underwent brain MR angiography. BA curvature was defined as the sum of the total BA horizontal deviation from midline at the distal tip, mid-pons, and vertebrobasilar junction, and was the primary independent variable in logistic regression analyses. BA measurements were obtained blinded to migraine status. We compared groups of all migraine vs no migraine, migraine without aura (MwoA) vs no migraine, and MA vs no migraine. Results: Of 880 participants, 146 had MwoA and 32 had MA. Average BA curvatures were 15.2 +/- 8.9 mm in non-migraineurs, 15.8 +/- 9.3 mm in MwoA, and 18.5 +/- 11.4 mm in MA. In an adjusted model, greater BA curvature was associated with MA (OR 1.042 per mm, 95% CI 1.006-1.080) but not with MwoA (OR 1.014 per mm, 95% CI 0.993-1.035), when compared to non-migraineurs. Conclusions: Greater BA curvature was associated with MA. Given aura typically originates from the occipital cortex, understanding the physiopathology of this association may provide clues to migraine's underlying mechanisms and relationship with stroke.