Women with migraines are more likely to have a larger increase of deep white matter hyperintensities (brian lesions) than females without migraines. However, the frequency, number, and severity of migraines are not associated with the progression of the lesions.
The finding, published in JAMA, came from a 10 year follow-up of subjects who had migraines and brian lesions that were recognized after they underwent magnetic resonance imaging.
The team, led by Inge H. Palm-Meinders, M.D., of the Leiden University Medical Center, the Netherlands, also discovered that an increase in the volume of deep white matter hyperintensity did not appear to have a significant impact on a poorer cognitive performance at follow-up.
About 15% of the general population experience migraine headaches. “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,” said Inge H. Palm-Meinders.
White matter hyperintensities have been linked to:
- heightened risk of ischemic stroke
- cognitive decline
- atherosclerotic disease risk factors
The experts set out to examine whether an increased prevalence of brain lesions was found on individuals with migraine headaches 9 years after their first MRI. They also wanted to find out whether migraine frequency was linked to brian lesion progression and whether the progression was linked to cognitive decline.
An Epidemiological Risk Analysis cohort, a study of Dutch participants suffering from migraine and an age- and sex-matched control group, was a follow-up of the 2000 Cerebral Abnormalities in Migraine. There were 295 participants at the start of the research in the migraine group and 140 in the control group. In 2009, 203 people in the migraine group and 83 in the control group underwent an MRI scan to determine progression of brain lesions.
The results were controlled for variables including age, sex, hypertension, educational level, and diabetes. The migraine group had an average age of 57 and 71% were female and the control group were 55 years old on average and 69% were female.
- 77% (112 out of 145) of participants in the migraine group had progression of deep white matter hyperintensities, compared to 60% (33 out of 55 in the control group)
- No link was shown between migraine and progression of MRI-measured brian lesions among males
- Migraine was linked to a higher incidence of infratentorial (an area of the brain) hyperintensities in women at follow-up
- Among females, no significant associations of migraine with progression of infratentorial hyperintensities or posterior circulation territory infarctlike lesions
The team added that no association was found between frequency of migraines, number of migraines, type of migraine, migraine severity, and migraine therapy with lesion progression. “Increase in deep white matter hyperintensity volume was not significantly associated with poorer cognitive performance at follow-up.”
The authors concluded:
“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.
This research raises questions about the impact migraine headaches have on the progression of cerebral vascular changes. Due to the functional implications of MRI brain lesions in females, the team said that further studies need to be conducted to explore the relationship between migraine and ischemia and ischemic stroke.
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, Arizona, wrote an accompanying editorial in order to determine how this finding can help doctors counsel patients who are suffering from migraines.
The experts wrote:
“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.”
Written by Sarah Glynn