Study author comment:
"... women who reported migraine with aura in middle age were at increased risk of late-life infarcts relative to those without migraine symptoms. The risk was primarily for cerebellar lesions; there was no increased risk for cortical or subcortical lesions in these women or for those with migraine without aura or nonmigraine headache. This risk was independent of cardiovascular risk factors measured in midlife or late life. Risk was not statistically different between individuals who were aged 50 years or younger vs those who were older when headache was ascertained or between those with a history of diagnosed CAD or TIA/stroke vs those without... Participants were also at low risk for TIA or stroke, making the identification of migraine visual aura symptoms more robust... Some limitations of this study should be taken into account when interpreting the findings. Because migraine symptom questions were not asked of those reporting headache less than once per month, we are likely capturing only those with severe migraine occurring with a higher frequency. Participants with aura only and no headache would be classified as having no migraine. Further, our assessment of migraine was based on pre-IHS diagnostic criteria, although the questions addressed 5 symptoms included in the IHS guidelines. We note that our estimated prevalence of migraine overall (eg, with or without aura) is highly consistent with prior studies... the clinical implications of the infarct-like lesions identified have not been established and will require investigation."1
Summary, comments, and perspective:
In an interview, when asked what she thinks is most important for patients to understand and take away from this research, Dr. Scher replied:
"Further studies are needed to asses whether these brain lesions have any clinical significance. If so, preventing accumulation of brain lesions may be an additional goal in managing migraine patients (for instance by risk factor modification, preventive therapy, or early abortion of migraine attacks). Until the need of these options has been determined, however, patients can be advised to reduce modifiable risk factors, such as smoking, hypertension, obesity and hypercholesterolemia (high cholesterol)."2
