Nirosen Vijiaratnam1, Daniel Barber2, Kai Zheong Lim2, Eldho Paul3, Matthew Jiang2, Benjamin Chosich4, Tissa Wijeratne2. 1. Department of Neurology, Western Health, Gordon Street Footscray, 3011 Victoria, Australia; Department of Neurology, Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia. Electronic address: nirosenv@gmail.com. 2. Department of Neurology, Western Health, Gordon Street Footscray, 3011 Victoria, Australia. 3. Department of Clinical Haematology, Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, Victoria, Australia. 4. Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Abstract
OBJECTIVES: Migraine is a debilitating condition that affects approximately 15% of the general population. It represents a huge proportion of presentations to the emergency department and a significant number of neurology admissions. Patients are often investigated with imaging. This is particularly the case with migraine with aura (MA). The yield of imaging is however low. There is limited information on Australian hospital presentations and utility of imaging. We aimed to analyse the demographics of migraine presentations to our hospital and the yield of imaging in our centre to help guide future approaches to these patients. PATIENTS AND METHODS: We retrospectively looked at medical records of patients presenting to the western health from January 2012 to June 2013. Patients were classified as either having migraine with aura or without. Baseline demographics, cardiovascular risk factors and imaging studies (CT brain, MRI brain and carotid Doppler studies) in each group were evaluated. Patients found to have white matter hyperintensities on MRI were further evaluated. RESULTS: We found patients with aura were more likely to have hypercholesterolemia (12% vs 7%, p=0.05). Patients with aura were more likely to be evaluated with imaging (CT brain (70% vs 41% p<0.0001) and MRI brain (44% vs 17% p<0.0001)). The patients investigated with imaging had no clinically significant findings. 21% of patients with aura were investigated with carotid Doppler studies. Only 1 patient had an abnormal result. Patients with white matter hyperintensities were older (51 vs 39 years; p<0.0001) and were more likely to have Hypertension (29% vs 14% p=0.019), Hypercholesterolemia (29% vs 11% p=0.003) and T2DM (16% vs 4% p=0.011). CONCLUSION: We found patients with MA and without aura to be largely similar. We also found imaging in either group to be of almost no clinical value.
OBJECTIVES:Migraine is a debilitating condition that affects approximately 15% of the general population. It represents a huge proportion of presentations to the emergency department and a significant number of neurology admissions. Patients are often investigated with imaging. This is particularly the case with migraine with aura (MA). The yield of imaging is however low. There is limited information on Australian hospital presentations and utility of imaging. We aimed to analyse the demographics of migraine presentations to our hospital and the yield of imaging in our centre to help guide future approaches to these patients. PATIENTS AND METHODS: We retrospectively looked at medical records of patients presenting to the western health from January 2012 to June 2013. Patients were classified as either having migraine with aura or without. Baseline demographics, cardiovascular risk factors and imaging studies (CT brain, MRI brain and carotid Doppler studies) in each group were evaluated. Patients found to have white matter hyperintensities on MRI were further evaluated. RESULTS: We found patients with aura were more likely to have hypercholesterolemia (12% vs 7%, p=0.05). Patients with aura were more likely to be evaluated with imaging (CT brain (70% vs 41% p<0.0001) and MRI brain (44% vs 17% p<0.0001)). The patients investigated with imaging had no clinically significant findings. 21% of patients with aura were investigated with carotid Doppler studies. Only 1 patient had an abnormal result. Patients with white matter hyperintensities were older (51 vs 39 years; p<0.0001) and were more likely to have Hypertension (29% vs 14% p=0.019), Hypercholesterolemia (29% vs 11% p=0.003) and T2DM (16% vs 4% p=0.011). CONCLUSION: We found patients with MA and without aura to be largely similar. We also found imaging in either group to be of almost no clinical value.