Akademik Veri Yönetim Sistemi
10th MENA Meeting 6th Turkish-African Meeting of Headache and Pain Management, Mersin, Türkiye, 17 - 19 Ekim 2025, (Özet Bildiri)
BACKGROUND: Vertebral artery hypoplasia (VAH) is a common vascular variant in the general
population and has been implicated in altered posterior circulation hemodynamics. While its
association with posterior circulation ischemic stroke is well recognized, the relationship between
VAH and migraine phenotypes, particularly chronic migraine, remains controversial. Previous studies
have reported inconsistent results with aura, headache laterality, and medication-overuse headache
(MOH). We aimed to investigate the frequency and laterality of VAH in migraine patients and its
relationship with migraine aura, chronicity, headache laterality, pain intensity, and MOH .
METHODS: This single-center, cross-sectional study included 91 patients diagnosed with migraine
according to ICHD-3 criteria. Vertebral artery diameters were measured via magnetic resonance
imaging angiography (MRA) and computerized tomography cerebral angiograms (CTA), and VAH
was defined as a diameter ≤2 mm and marked side-to-side asymmetry (1). Clinical variables included
migraine chronicity (chronic vs episodic), presence of aura, headache laterality, Numeric Rating Scale
(NRS) pain score, presence of MOH, smoking and alcohol use, history of stroke or atherosclerotic
disease, and presence of mood/anxiety disorders. Categorical variables were compared using the
Mann-Whitney U test; continuous variables with the t-test as appropriate. Correlation analysis and
binary logistic regression were performed.
RESULTS: In the present study, 72 of the migraineurs were women, and the mean age was 43.3±12.6.
VAH was observed in 58% (40% right, 13% left) of migraine patients. Right VAH was associated with
migraine chronicity (p = 0.024) and MOH (p=0.033). Right vertebral artery diameter demonstrated
a significant correlation with chronic migraine (p=0.028, r=0.230) and MOH (p=0.032, r=0.225).
No significant associations were found between VAH and aura, headache laterality, or NRS. Binary
logistic regression did not identify VAH as an independent predictor of migraine chronicity or MOH
after adjusting for potential confounders. Vascular risk factors and psychiatric comorbidities were
not significantly different between VAH and non-VAH groups.
CONCLUSION: In this migraine cohort, VAH—particularly right-sided hypoplasia—was common and
associated with migraine chronicity at the univariate level, but not as an independent predictor
after multivariate adjustment. VAH was observed at a higher frequency than population-based
reports. Right-sided hypoplasia was more prevalent than left-sided hypoplasia, comparable to
previous reports. Studies have reported a higher incidence (40%) of VAH in patients with posterior
circulation stroke, demonstrating that changes in posterior circulation hemodynamics are significant
in these patients. Although our cohort included a small number of stroke patients (4.3%, only 1 of
them had VAH), a high ratio of VAH was observed, suggesting that changes in posterior circulation hemodynamics may also occur in migraine patients and may have an impact on pain chronicity and
MOH. Further studies in larger populations are required to confirm the effect of posterior circulation
hemodynamics on migraine chronicity and MOH
Key words: vertebral artery hypoplasia, migraine, chronic migraine, medication overuse headache,
posterior circulation.