Migraine with Aura Linked to Late-Life Brain Lesions

Patient Expert

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Until recently, Migraine was considered to be an episodic disease with no long-term consequences or effects. In the last few years, however, we've seen reports of studies suggesting that Migraine may well be associated with changes in the brain and may be a progressive disease. (See Is Migraine a Progressive Brain Disease? and Yes, Migraines Can Cause Brain Damage.

A new study funded**, in part, by the Migraine Research Foundation and published in JAMA confirms some earlier findings. Before we panic, however, let's take a good look at the study, it's implications, and where we go from here.

Study objective:

"To determine whether individuals not reporting headache compared with individuals reporting migraine symptoms, particularly aura, in midlife are at increased risk of late-life infarct-like lesions* found on magnetic resonance imaging (MRI) without consideration of clinical symptoms."1

Study methods:

  • A group of 4,689 study participants (2,693 women and 1,996 men) were followed from 1967 through 2006.

  • The participants were interviewed regarding Migraine symptoms in mid-life.

  • Subject ages ranged from 33 years to 65 years.

  • Between 2002 and 2006, MRIs of the brain were performed on participants.

  • Participants reporting headaches were classified as having Migraine without aura, Migraine with aura, or non-Migraine headaches after being surveyed about Migraine symptoms including nausea, unilateral location, photophobia, visual disturbance, and numbness.

  • Full cardiovascular risk assessments were completed at both the beginning (1967) and end of the study period.

Study main outcome measure:

"Presence of infarct-like lesions (total) and specifically located in the cortical, subcortical, and cerebellar regions."1

Study results:

  • Infarct-like lesions were present in 39.3% of men and 24.6% of women.
  • Prevalence of cerebellar lesions in women with migraine with aura was 23.0 percent vs. 14.5 percent for women not reporting headaches.
  • There was no statistically significant difference in prevalence of these lesions in men.
  • Migraine without aura and nonmigraine headache were not associated with an increased risk.

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

With each study that shows a possible connection between Migraine and brain lesions, the evidence mounts that Migraine may indeed cause brain damage. To date, these lesions seem to be subclinical, which means that they cause no symptoms.

Anecdotally, I often hear from Migraineurs who are having memory and other cognitive problems. I'm often asked if Migraine can cause permanent loss of memory, problems with concentration, and other problems. The does lead one to wonder if Migraines are damaging our brains in some way.

Until we have definite answers to the question of possible brain damage from Migraine disease, it certainly cannot hurt to do a couple of things:

  • We can educate ourselves about Migraine and work with our doctors toward the best treatment regimen possible, including Migraine prevention.
  • We can work with our doctors to live as health a lifestyle as possible. As Dr. Sher said, "reduce modifiable risk factors, such as smoking, hypertension, obesity and hypercholesterolemia."

Especially when we consider that these actions would bring us better health and a higher quality of life, there's no reason not to take these actions now rather than waiting for research to tell us whether Migraines cause true brain damage or not.

Putting this in perspective -- This research is not a reason for panic. It IS a reason for beginning or continuing to work with our doctors on both good Migraine management and a healthy lifestyle.

  • An infarct is an area of necrosis (death of living tissue) resulting from obstruction of blood flow.

** This study was funded by the National Institute on Aging, the Icelandic Heart Association and the Icelandic Parliament. Components of the study were also supported by the National Eye Institute, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute and the Migraine Research Foundation.


Sources:

1 Ann I. Scher; Larus S. Gudmundsson; Sigurdur Sigurdsson; et al. "Migraine Headache in Middle Age and Late-Life Brain Infarcts." JAMA. 2009;301(24):2563-2570 (doi:10.1001/jama.2009.932)

2 Interview with Ann I Scher. Teri Robert. June 25, 2009.

3 News Release. "Migraines with Aura in Middle Age Associated with Late-Life Brain Lesions." NIH News. June 23, 2009.

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