Migraine-Related Hyperintensities May Not Be Associated With Cognitive Decline



Deep white matter hyperintensity volume was higher at baseline and at follow-up among women with migraine than among female controls, according to research published in the November 14 JAMA. Among women, migraine was associated with progression of hyperintensities, but not with progression of other lesions. Increase in deep white matter intensity volume was not significantly associated with poorer cognitive performance at follow-up. Migraine was not associated with progression of any brain lesions in men.

Approximately 21% of women with migraine had infratentorial hyperintensities at follow-up, compared with 4% of female controls. Progression of infratentorial hyperintensities, however, was not significantly greater among women with migraine than among female controls. In addition, migraine was not associated with new posterior circulation territory infarctlike lesions.

In 2009, Inge H. Palm-Meinders, MD, Physician-Researcher in Radiology at Leiden University Medical Center in the Netherlands, and her colleagues followed up 286 patients who had participated in the CAMERA migraine study in 2000. Patients underwent a phone interview, brain MRI, physical exam, and cognitive testing. All participants gave information about previous, current, and newly developed migraine since 2000. The study’s primary outcome measure was change in number and volume of MRI-measured deep white matter hyperintensities in individuals with migraines compared with controls during follow-up.

Of the 286 patients, 114 had migraine with aura, 89 had migraine without aura, and 83 were controls. Patients’ mean age was 57, and 202 participants were women. Mean follow-up was 8.5 years.

The number of migraine attacks, frequency of migraines, migraine severity, type of migraine headaches, and migraine therapy were not associated with lesion progression. More frequent migraine headaches, however, were associated with a higher prevalence of MRI findings.

The study’s finding that progression of deep white matter hyperintensities was confined to women “is in line with results from another study and consistent with the higher risk of brain infarcts in women with migraine,” said Dr. Palm-Meinders. “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.”

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