Can nailfold videodermatoscopy detect microvascular alterations in patients with migraine? A prospective case-control study.

BACKGROUND

Migraine is a neurovascular disorder increasingly associated with systemic microvascular dysfunction. Nailfold capillary assessment provides a noninvasive method for evaluating peripheral microvascular abnormalities. This study aimed to evaluate nailfold capillary alterations using videodermatoscopy in patients with migraine and their associations with migraine-related clinical characteristics.

METHODS

This prospective, observational, cross-sectional case-control study included 77 patients with migraine and 91 age- and sex-matched healthy controls. Nailfold videodermatoscopy was used to assess capillary dilatation, giant capillaries, microhemorrhages, capillary loss, avascular areas, increased tortuosity, branched capillaries, and edema. Clinical characteristics included VAS, MIDAS, monthly headache days, aura status, and disease duration.

RESULTS

Patients with migraine exhibited significantly higher frequencies of branched capillaries, increased tortuosity, microhemorrhages, capillary loss, avascular areas, edema, giant capillaries, and capillary dilatation than controls. Associations with microhemorrhages, increased tortuosity, and capillary dilatation remained significant after adjustment for age and sex (all p < 0.001). Among patients with migraine, microhemorrhages were associated with lower hemoglobin, creatinine, body mass index, and hematocrit; giant capillaries with lower body mass index and higher neutrophil counts; and capillary loss with higher glucose levels. Nailfold abnormalities were not significantly associated with migraine severity, monthly headache days, disability, aura status, or disease duration.

CONCLUSIONS

Patients with migraine exhibited significantly more nailfold microvascular abnormalities than healthy controls. These findings suggest potential systemic microvascular involvement in migraine and indicate that nailfold videodermatoscopy may represent a practical, noninvasive tool for assessing peripheral microvascular alterations. Further multicenter prospective studies are warranted.