Association of transverse sinus stenosis and dominant venous sinus drainage pattern with chronic migraine: A matched case-control study

Recent studies have indicated that transverse sinus stenosis (TSS) is an imaging feature in patients with chronic migraine (CM). However, the clinical significance of this imaging finding in CM remains unclear. Moreover, the role of the dominant venous sinus drainage pattern in CM remains to be elucidated. This matched case-control study aimed to investigate the associations of TSS and venous sinus dominance pattern with CM. This study included 94 patients with CM and 94 sex- and age-matched controls. All included patients underwent magnetic resonance venography. Dominant venous sinus drainage pattern (right-dominant, left-dominant, or equally dominant) was quantitatively assessed by consultant neuroradiologists. Venous sinus stenosis was determined using the combined conduit score (1-8) and was further classified into 3 categories: bilateral stenosis, unilateral stenosis, and no stenosis. No significant difference was found in the dominant venous sinus drainage pattern between CM and control patients. Multivariable logistic regression analysis demonstrated a strong positive correlation between TSS and CM (bilateral: odds ratio = 6.60, 95% confidence interval: 2.30-18.91; unilateral: odds ratio = 2.41, 95% confidence interval: 1.01-5.26; all P < .05). Venous sinus dominance pattern did not differ between CM patients and controls. In contrast, TSS (particularly bilateral) was significantly associated with CM. These findings suggest a potential association between impaired cerebral venous outflow and migraine chronification; however, causality cannot be inferred.