Brain Lesions Also Evident in Nonmigraine Headache, but Cognitive Function Unaffected

Megan Brooks

January 28, 2011

January 28, 2011 — Older people with a history of any severe headache, not just migraine headache, are more likely to have structural white matter brain lesions than their headache-free peers, a new study suggests.

"Our findings extend our knowledge of the association between headache and white matter hyperintensities to nonmigraine headache, which is likely to be tension-type headache, and to older people," the study team writes in the January 18 issue of BMJ.

The study also shows that migraine or other severe headache type by itself or in combination with brain lesions does not result in cognitive impairment. Until now, it was unclear whether structural brain lesions among people with headache impair cognitive function, the study authors note in their report.

"This is a very reassuring result for the many people who suffer from migraine," first study author Tobias Kurth, MD, MSc, ScD, told Medscape Medical News. "In spite of the increased presence of brain lesions, migraine does not seem to increase the risk of cognitive decline with or without such lesions. Therefore, we do not find negative consequences of migraine on the brain," he said.

Dr. Tobias Kurth

Dr. Kurth is director of research, INSERM Unit 708-Neuroepidemiology, Paris, France. He is also affiliated with Brigham and Women's Hospital and Harvard Medical School, both in Boston, Massachusetts.

This study shows that nonmigraine headaches "may also be associated with some evidence of diffuse vascular damage in the brain," Lenore J. Launer, PhD, chief of neuroepidemiology at the National Institute on Aging in Bethesda, Maryland, who was not involved in the study, told Medscape Medical News.

"I think this paper, in particular, raises the flag," she said, to have researchers start looking at vascular damage in other nonmigraine types of headaches. "That's a new message."

A 'New Message'

The study team evaluated the association of overall and specific headache types with volume of white matter intensities, brain infarcts defined as focal lesions of 3 mm or more, and cognitive function assessed by a battery of tests, including the Mini-Mental State Examination (MMSE).

The study included 780 older adults (mean age, 69 years) participating in the population-based Epidemiology of Vascular Ageing study. Of these, 163 (20.9%) had a history of severe headache and 116 had migraine, of whom 17 (14.7%) reported aura symptoms.

According to the investigators, having any severe headache history was associated with increasing volume of white matter lesions. The adjusted odds ratio (OR) of being in the highest third for total volume of white matter hyperintensities was 2.0 (95% confidence interval [CI], 1.3 – 3.1; P for trend = .002) for those with a history of any severe headache compared with those in the lowest third without a headache history.

The associations were similar for volume of deep and periventricular white matter hyperintensities. However, stronger associations were found between migraine with aura and deep white matter hyperintensities (adjusted OR, 12.4; 95% CI, 1.6 – 99.4; for the highest third, P for trend = .005).

The findings of a strong association between migraine with aura and deep white matter lesions extend the findings of the Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis (CAMERA) study (JAMA. 2004;291:427-434).

In this population-based sample of men and women aged 20 to 60 years from the Netherlands, overall migraine was associated with an increased volume of deep white matter lesions among women but did not differ by migraine aura status.

Brain Infarcts Only in Migraine With Aura

At least 1 brain infarct was seen in 110 subjects (14.1%). Subjects with a history of migraine or nonmigraine headache had no increased risk of brain infarct, relative to their headache-free peers.

However, those with migraine with aura had more than a 3-fold increased risk of a brain infarct (adjusted OR, 3.4; 95% CI, 1.2 – 9.3). There was also a suggestion of increased risk of multiple brain infarcts in subjects with migraine with aura.

Because the association between headache and brain infarcts is limited to the small subgroup of migraine with aura, "our data do not support ordering brain imaging to rule out structural brain lesions for most people with primary headache disorders," Dr. Kurth and colleagues write.

Most brain infarcts they detected were located outside the cerebellum. This finding differs from the population-based Reykjavik Study, reported by Dr. Launer and colleagues in the Journal of the American Medical Association in 2009 (JAMA. 2009;301:2563-2570).

The Reykjavik Study found that women who experience migraine with aura in middle age are more likely than women without such headaches to have cerebellar infarct–like lesions evident on magnetic resonance imaging during old age. The CAMERA study also found an association between migraine with aura and infarct-like lesions, mainly in the cerebellum and brainstem.

The current study "didn't replicate the findings about the cerebellar infarcts, and we can't exclude the possibility that the scans in the 2 studies were different in terms of precision," Dr. Launer commented.

Headaches Don't Harm Thinking

The researchers had MMSE scores for 769 of the 780 subjects. The scores ranged from 17 to 30 (mean, 27.6), and mean scores did not differ by headache status ( P = .17). There was no association between overall or specific headache types and impaired cognitive function on the MMSE, regardless of the presence of brain lesions.

The researchers note in their report that the battery of cognitive function tests they used yielded similar association patterns, and they chose to report only findings from the MMSE in the current article.

"I would have liked to see the other test results," Dr. Launer commented. "The MMSE is a global test of cognition and is frequently used to screen for dementia, and it's possible that more specific areas of cognition may be affected," she noted.

Dr. Kurth said they only report the MMSE results now because of space limitation and because cognition is only 1 aspect of this article. He said they are currently submitting the full cognitive data in a separate manuscript that also looks at cognitive decline during follow-up, and "there is no association with migraine."

The Epidemiology of Vascular Ageing study was performed under an agreement among INSERM, Merck, Sharp, and Dohme-Chibret Laboratories (West Point, Pennsylvania) and EISAI (Paris, France). The study was supported by a grant to Dr. Kurth from the French National Research Agency. The study authors and Dr. Launer have disclosed no relevant financial relationships.

BMJ. Published online January 18, 2011.


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