According to background information in the article, research has suggested an increased prevalence of cerebral infarction and white matter lesions (WMLs) is present in migraine patients. Infarction involves tissue which has died due to lack of oxygen resulting from a blood clot blocking an artery. It is not known whether WMLs are prevalent in the general migraine population.
Mark C. Kruit, M.D., of Leiden University Medical Center, Leiden, The Netherlands, and colleagues investigated whether persons with migraines from the general population are at increased risk of brain infarcts and WMLs or whether this risk varies by migraine subtype and attack frequency.
The study involved a sample of Dutch adults aged 30 to 60 years who were randomly selected patients with migraine with aura (visual disturbance ) (n=161), patients with migraine without aura (n=134), and controls (n=140). Brain magnetic resonance images (MRIs) were evaluated for infarcts and for WMLs.
The researchers found no significant difference between patients with migraine and controls in overall infarct prevalence (8.1 percent vs. 5.0 percent). "However, in the cerebellar region of the posterior circulation territory, patients with migraine had a higher prevalence of infarct than controls [5.4 percent vs. 0.7 percent; more than seven times the risk]," the authors write. Patients with migraine with aura had more than 13 times the risk for infarct than controls. In patients with migraine with a frequency of attacks of 1 or more per month, there was a 9.3 times increased risk. The highest risk for infarct was in patients with migraine with aura with 1 attack or more per month (15.8 times increased risk).
Women with migraine had twice the risk for deep WMLs compared with controls. This risk increased with attack frequency (highest in those with 1 of more attacks per month, 2.6 times increased risk) but was similar in patients with migraine with or without aura. Male controls and patients with migraine did not differ in the prevalence of deep WMLs.
"Based on the current evidence, further study into the possible etiologic mechanisms of brain lesions in migraine patients is required. This will not only provide important clues about the pathophysiology of migraine but also contribute to management guidelines for migraine," the researchers write. (JAMA. 2004;291:427-434. Available post-embargo at JAMA.com)
Editor's Note: This study was supported by grants from the Netherlands Heart Foundation, Den Haag, the Netherlands and the Asclepiade Foundation, Geneva, Switzerland, and was performed in cooperation with the Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
EDITORIAL: IS MIGRAINE A PROGRESSIVE BRAIN DISEASE?
In an accompanying editorial, Richard B. Lipton, M.D., and Jullie Pan, M.D., Ph.D., of Albert Einstein College of Medicine, Bronx, N.Y., examine the study by Kruit et al.
The study by Kruit et al and other studies have implications for current concepts of migraine as a disease; migraine should be conceptualized as a chronic-episodic and sometimes chronic progressive disorder. "With this shift in conceptualization, the goals of treatment may also shift. Preventing disease progression in migraine has already been added to the traditional goals of relieving pain and restoring patients' ability to function," they write.
"If the brain lesions demonstrated by Kruit et al have a significant clinical correlate, preventing the accumulation of brain lesions may become an additional goal of treatment. Emerging treatment strategies to prevent disease progression, including risk factor modification, preventive therapies, and the early use of acute treatments, are an important focus for future investigation," they conclude. (JAMA. 2004;291:493-494. Available post-embargo at JAMA.com)
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