After nearly 10 years of
follow-up of study participants who experienced migraines and who had brain
lesions indentified via magnetic resonance imaging, women with migraines had a
higher prevalence and greater increase of deep white matter hyperintensities
(brain lesions) than women without migraines, although the number, frequency,
and severity of migraines were not associated with lesion progression,
according to a study appearing in the November 14 issue of JAMA.
Also, increase in deep white matter hyperintensity volume was not significantly
associated with poorer cognitive performance at follow-up.
Migraine affects up to 15
percent of the general population. "A previous cross-sectional study
showed an association of migraine with a higher prevalence of magnetic resonance
imaging(MRI)-measured ischemic lesions in the brain," according to
background information in the article. White matter hyperintensities are
associated with atherosclerotic disease risk factors, increased risk of
ischemic stroke, and cognitive decline.
Inge H. Palm-Meinders, M.D., of
the Leiden University Medical Center, the Netherlands, and colleagues conducted
a study to determine whether women and men with migraine headacheshave a
higher incidence of brain
lesions 9 years after initial MRI, whether migraine frequency was
associated with progression of brain lesions, and whether progression of brain
lesions was associated with cognitive decline. In a
follow-up of the 2000 Cerebral Abnormalities in Migraine, an
Epidemiological Risk
Analysis cohort, which is a population-based observational study of
Dutch participants with migraine and an age- and sex-matched control group, 203
of the 295 participants at the beginning of the study in the migraine group and
83 of 140 in the control group underwent MRI scan in 2009 to identify
progression of MRI-measured brain lesions. Comparisons were adjusted for age,
sex, hypertension, diabetes, and educational level. The participants in the
migraine group were an average of 57 years of age, and 71 percent were women.
Those in the control group had an average age of 55 years, and 69 percent were
women.
The researchers found that of the
145 women in the migraine group, 112 (77 percent) vs. 33 of 55 women (60
percent) in the control group had progression of deep white matter
hyperintensities. Among men, no association was found between migraine with
progression of MRI-measured brain lesions. Although migraine was associated
with a higher prevalence of infratentorial (an area of the brain)
hyperintensities at follow-up, there were no significant associations of
migraine with progression of infratentorial hyperintensities or posterior
circulation territory infarctlike lesions among women.
"In addition, the number of
migraines, frequency of migraines, migraine severity, type of migraine, and
migraine therapy were not associated with lesion progression," the authors
write. "Increase in deep white matter hyperintensity volume was not
significantly associated with poorer cognitive performance at
follow-up."
"In summary, in a
community-based cohort followed up for 9 years, migraine was associated only
with a higher incidence of deep white matter brain changes among women. There
were no significant associations of migraine with progression of other brain
lesions among women, and there were no associations of migraine headache with
progression of any brain lesions among men. These findings raise questions
about the role of migraine headaches with progression of cerebral vascular
changes. The functional implications of MRI brain lesions in women with
migraine and their possible relation with ischemia and ischemic stroke warrant
further research."
In an accompanying editorial,
Deborah I. Friedman, M.D., M.P.H., of the University of Texas Southwestern
Medical Center, Dallas, and David W. Dodick, M.D., of the Mayo Clinic,
Scottsdale, Ariz., examine the question of how the results of this study can
help physicians advise patients with migraine.
"The findings imply that
small white matter hyperintensities in most patients with migraine should not
be a reason for alarm. However, given the relationship between migraine and
several acquired and genetic vasculopathies, it is possible that certain
subpopulations of patients with migraine with white matter
hyperintensities may be at an increased genetic risk for significant
white matter disease and neurological morbidity, including stroke, transient
ischemic attack, cognitive impairment, and other neurologic outcomes.
Addressing modifiable risk factors for stroke—such as obesity, smoking,
hypertension, hypercholesterolemia, and physical inactivity—and avoiding
high-dose combined oral contraceptives in women older than 35 years and in
those with untreated or poorly controlled vascular risk factors seems prudent.
Further research and advances in genetics will provide additional
answers."
More information: JAMA.
2012;308(18):1889-1897 / JAMA. 2012;308(18):1920-1921
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