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Migraine linked to risk of brain lesions in women

Tuesday November 13, 2012
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After nearly 10 years of follow-up of study participants who experienced migraines and those who had brain lesions identified via magnetic resonance imaging, women with migraines had a higher prevalence and greater increase of deep white matter hyperintensities than women without migraines, according to a study.

However, the number, frequency and severity of migraines were not associated with lesion progression, researchers found. And increase in deep white matter hyperintensity volume was not significantly associated with poorer cognitive performance at follow-up.

Migraine affects up to 15% of the general population, and the researchers noted that a previous cross-sectional study showed an association of migraine with a higher prevalence of MRI-measured ischemic lesions in the brain. White matter hyperintensities are associated with atherosclerotic disease risk factors, increased risk of ischemic stroke and cognitive decline, the researchers noted in background information for the study, which appears in the Nov. 14 issue of the Journal of the American Medical Association.

Inge H. Palm-Meinders, MD, of the Leiden University Medical Center in the Netherlands, and colleagues conducted a study to determine whether women and men with migraine headaches have a higher incidence of brain lesions nine 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 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 average age of the participants in the migraine group was 57, and 71% were women. The average age of those in the control group was 55, and 69% were women.

The researchers found that of the 145 women in the migraine group, 112 (77%), versus 33 of 55 women (60%) in the control group, had progression of deep white matter hyperintensities. Among men, no association was found between migraine and progression of MRI-measured brain lesions.

Although migraine was associated with a higher prevalence of infratentorial hyperintensities at follow-up, there were no significant associations of migraine with progression of infratentorial hyperintensities or posterior circulation territory infarctlike lesions among women.

The researchers added that migraine therapy and the number, frequency, severity and type of migraine were not associated with lesion progression. Increase in deep white matter hyperintensity volume was not significantly associated with poorer cognitive performance at follow-up.

In conclusion, the findings "raise questions about the role of migraine headaches with progression of cerebral vascular changes," the authors wrote. "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, MD, MPH, of the University of Texas Southwestern Medical Center in Dallas, and David W. Dodick, MD, of the Mayo Clinic in Scottsdale, Ariz., examined how the results of the study might 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," they wrote. "However, given the relationship between migraine and several acquired and genetic vasculopathies, it is possible that certain subpopulations of patients with migraine [and] 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."

The study is available at http://jama.jamanetwork.com/article.aspx?articleid=1391911.


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