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However, large population-based prospective studies failed to document temporal Trichostatin A in vivo associations between the number of migraine headache attacks and brain lesion progression [88,89]. Clinical significance of WMH seen in migraine patients is still unclear. Cognitive dysfunction seems not to be associated with WMH in migraineurs [90,91]. Migraine and hemorrhagic stroke In addition to higher risk of ischemic stroke, migraineurs also have a risk for developing hemorrhagic stroke. Women��s Health Study demonstrated increased risk for hemorrhagic stroke in women with active migraine with aura (adjusted HR 2.25, 95% CI 1.11-4.54) [92]. A meta-analysis revealed that the risk of hemorrhagic strokes was greater in females with any types of migraine and in female migraineurs aged less than 45 years [93]. However, in a recent population-based study, the risk of hemorrhagic stroke increased irrespective of sex or age group (Casein kinase 2 conditions that cause both stroke and migraine Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) Migraine and ischemic stroke are common features Vismodegib datasheet of CADASIL, which is a disorder of small cerebral arteries [96]. Transient ischemic attacks and ischemic strokes are the most frequent manifestations in CADASIL, occurring in 60%-85% of patients [97-99]. Migraine with aura is reported in 20%-50% of patients with CADASIL, which is five times greater than in the general population. In a Korean cohort of CADASIL, headache is the most frequent symptom with a prevalence of 45.3%, followed by cerebral infarction [100]. Headache is usually the first symptom, with an average age at onset of 30 years [101]. The nature of headache is generally similar to those of classic migraine [100]. However, older age of onset and higher frequency of atypical aura can be found in patients with CADASIL [101]. Notch-3 mutation is the gene involved in CADASIL, encoding a transmembrane receptor primarily expressed in systemic arterial smooth-muscle cells [102]. Genetic testing is the gold standard for the diagnosis of CADASIL, showing very high sensitivity and specificity, reaching 100% [103]. Skin biopsy can be helpful. Presence of granular osmiophilic material on electron-microscopic study of skin biopsy samples indicates arteriopathy of CADASIL, but the sensitivity is variable [104]. MRI can present abnormalities prior to clinical onset. Characteristic imaging findings are T2 hyperintense lesions in the temporal pole, external capsule and corpus callosum [105].