Page 172 - Migraine, the heart and the brain

Chapter 9
and coordination, perceptual intelligence and motor function, cerebellar motor coordination and learning of limb movements, associative cerebellar motor learning and vestibular motor coordination.(Chapter VII).
Our study was the rst to assess a broad range of cerebellar functions in a population based study and with investigators blinded for migraine/ control status. We failed to nd any evidence of impaired cerebellar function using an array of tests covering the functions of the main parts of the cerebellum. Previous studies which suggested subclinical cerebellar dysfunction were all small clinical based and unblinded.34-38 Our test battery consisted of highly sensitive clinical tests, which was shown by the fact that they did show de cits in a relatively small group of FHM patients which were tested with the same test protocol. Thus, in contrast to previous ndings, our ndings argue against the hypothesis that cerebellar function is subclinically impaired in migraine patients. Also in general these cerebellar infarcts did not cause any functional impairment.
future perspeCtives
We showed that both subclinical cerebellar infarcts as well as deep white matter hyperintensities in migraine patients occur irrespective of current migraine activity or past and present attack load. Most likely an underlying factor, for instance endothelial dysfunction or a shared genetic factor may be the causal link in this association. The role of comorbid RLS on ischemic lesions seems small, if any. Future studies should focus on identifying the underlying mechanism between migraine and white matter lesions in women.
The association between RLS and migraine with aura, which we now demonstrated in the general population, adds to the evidence that emboli can be able to induce cortical spreading depression which is the underlying mechanism for the migraine aura. However, as evidence for a prophylactic effect of RLS closure is currently still lacking, we advice against screening for RLS in migraine with aura patients.
Although migraine is associated with subclinical structural brain changes, this seems unrelated to attack load and these lesions do not cause functional impairment. Also does migraine (by any other mechanism) not lead to impairment of brainfunction. Future studies should focus on identifying the underlying mechanism between migraine and white matter lesions speci c in women.
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