Later-Life Brain Lesions Found in Migraine-Prone Women
By Chris Emery, Contributing Writer, MedPage Today
Published: June 23, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
PRINCETON, June 23 -- Middle-aged women who suffered migraine headaches accompanied by sensory disturbances or difficulty speaking (aura) had higher incidence of brain lesions later in life, according to a study of Icelandic patients.
Action Points  

    * Note that the clinical implications of the relationship between infarct-like lesions and migraines with aura have not yet been established.

    * Monitor the medical literature for new studies examining the link between migraines and structural brain changes and brain function that may clarify the association between migraines and late-life brain lesions.

Women who reported migraines with aura in midlife were 1.9 times more likely to have infarct-like cerebellar lesions late in life than women without similar headaches (95% CI 1.4 to 2.6), researchers reported in the June 24 Journal of the American Medical Association.

"This is consistent with the hypothesis that migraine with aura in midlife is associated with late-life vascular disease in the cerebellum and in women," wrote Ann I. Scher, PhD, of the Uniformed Services University, and colleagues.

About one-third of individuals who suffer migraines experience neurological aura symptoms before headache onset, usually consisting of transient visual disturbances and other sensory, aphasic, or motor disturbances, according to the authors.

Recent studies have suggested that migraine with aura is associated with an increased risk of clinically evident stroke or coronary artery disease, so Scher and colleagues chose this study to shed more light on the relationship between migraines and vascular disease.

They examined the relationship of migraine symptoms and late-life infarct (tissue death) among 4,689 men and women in Reykjavik, Iceland, who participated in a population-based health study by the Icelandic Heart Association.

The participants were first interviewed about migraine symptoms beginning in 1967, when their average age was 51. Follow-up interviews were conducted more than 26 years later, between 2002 and 2006, at which time the participants received MRI scans for brain lesions.

Infarct-like lesions were present in 39.3% of men and 24.6% of women.

The researchers adjusted for age, sex, and follow-up time. They found that compared with those not reporting headaches once or more per month (n=3,243), those with midlife migraine with aura (n=361) had an increased risk of late-life infarct-like lesions (adjusted OR 1.4, 95% CI 1.1 to 1.8).

The difference specifically reflected an association with cerebellar lesions in women.

Of the women who reported migraines with aura, 23% showed signs of brain lesions, while only 14.5% of women who reported no headaches had lesions (OR 1.9, 95% CI, 1.4 to 2.6).

The increased risk was independent of cardiovascular risk factors measured in midlife or late life. The study found no significant migraine-related difference in lesion prevalence among men.

The authors wrote that proposed mechanisms to explain the link between migraines and brain lesions, including traditional cardiovascular risk factors, endothelial dysfunction, and shared genetic risk factors for migraine and stroke, do not explain why migraine-related lesions were found in the cerebellum or in women.

"Why migraine, particularly with aura, is associated with clinical and silent (presumed) ischemic stroke is uncertain," they wrote.

They noted that previous studies have suggested vulnerabil