Occipital bending in migraine with visual aura

Abstract

Objective To analyze occipital bending (OB) frequency in patients with migraine with visual aura compared with those without aura. Background A unique type of asymmetry in the human brain in which one occipital pole crosses the midline and bends over the other pole is called OB. OB frequency has been shown to be related to major psychiatric diseases. Hence, it may suggest more than an anatomical variation. Structural differences in the brain have been demonstrated but unequivocally between patients with migraine with aura and without aura. OB is newly recognized, and we aimed to evaluate its frequency among patients with migraine. Methods For this retrospective cohort study, we reviewed our records from 2016 to 2021 from a database of the outpatient headache clinic of Koc University Hospital. Results We found 84 patients with migraine who fulfilled diagnostic criteria for migraine with aura and migraine without aura and also had cranial magnetic resonance imaging. The median age of the population was 40 (IQR, 32-52). The female-to-male ratio of participants was 2:1. A quarter of the patients had visual aura. The prevalence of OB in patients with migraine in our retrospective study was 33.3% (28/84). Between our study groups, OB was significantly higher in patients with migraine with visual aura (57.1%, 12 out of 21 patients) than in those without aura (25.4%, 16 out of 63), (odds ratio 3.9 (95% confidence interval 1.4 to 11.0), p = 0.015). Conclusion OB frequency is two times higher in patients with migraine with visual aura. It may have pathophysiological implications.