"Based on the current evidence, further study into the possible etiologic mechanisms of brain lesions in migraine patients is required.
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This will not only provide important clues about the pathophysiology of migraine but also contribute to management guidelines for migraine. Based on the finding of higher risks in those with higher migraine attack frequency, it is necessary to assess whether prevention or (early) abortion of migraine attacks will also decrease the risk for brain lesions and whether there is a subgroup most likely to benefit."
Other specialists comment on the study and article:
In an editorial also in JAMA, Dr. Richard B. Lipton and Dr. Julie Pan said that the Kruit et al article presented "important new data on the prevalence of brain infarction and white matter lesions in persons with migraine." Their editorial is very aptly titled, "Is Migraine a Progressive Brain Disease?"2
Lipton and Pan emphasize:
"These data have implications for current concepts of migraine as a disease; migraine should be conceptualized not just as an episodic disorder but as a chronic-episodic and sometimes chronic progressive disorder. With this shift in conceptualization, the goals of treatment may also shift. Preventing disease progression in migraine has already been added to the traditional goals of relieving pain and restoring patients' ability to function. If the brain lesions demonstrated by Kruit et al have a significant clinical correlate, preventing the accumulation of brain lesions may become an additional goal of treatment. Emerging treatment strategies to prevent disease progression, including risk factor modification, preventive therapies, and the early use of acute treatments, are an important focus for future investigation."2
Dr. Joel R. Saper, director of the Michigan Head Pain and Neurological Institute in Ann Arbor, told ABC News: "You might have a patient who says, 'I can live with three headaches per week.' This study, if validated, means maybe they shouldn't ... If we say that progressive changes are occurring in the brain from recurring and repetitive attacks … then there's a greater burden on preventing those attacks." 3
