Virchow-Robin spaces in childhood migraine

Virchow-Robin spaces (VRS) are pia-lined extensions of the subarachnoid spa ce which surround penetrating arteries as they enter the brain on its surfa ce. Using high-resolution MRI, which shows small penetrating arteries, we s tudied a possible association of accentuated VRS in children with tension-t ype headache (TTH) or migraine. We studied 58 children aged 3-14 years (mea n 10.8 years) with a clinical diagnosis of migraine (31) or TTH (27), who u nderwent cerebral MRI, and 30 headache-free patients of the same age (mean 10.2 years) and 30 adult migraineurs with postpubertal onset of symptoms, w ho served as controls. The images were reviewed for structural abnormalitie s in the regions of the small penetrating arteries. Accentuated VRS were fo und in 61% of the children with migrainous headaches and in 22% of children of those with TTH. Prominent VRS were seen in 27% of the control children and in only 13% of the adults. Small infarcts and gliosis were rare in chil dren with or without headache, but were seen in 30% of the adult migraineur s. Our findings show that accentuated VRS are significantly more common in children with migraine than in those with TTH or headache-free controls. De tection of accentuated VRS may therefore enhance differential diagnosis of primary headaches in children, contributing to an improvement in management .