Page 49 - Migraine, the heart and the brain

would support the hypothesis that ischemia may occur during attacks.22 However, our
nding that migraine was not signi cantly associated with progression of all evaluated
types of brain lesions at the 9-year follow-up raises questions about the role of cerebral
ischemia over time in people with migraine.21,23 2 Possible explanations for an association of migraine headache with structural brain
changes include a chronic procoagulatory or proinflammatory state due to endothelial dysfunction24,25 or elevated homocysteine levels,26,27 or recurrent paradoxical (micro-) emboli due to right-to-left shunts.28 Increased incidence of brain lesions among people with migraine headaches and atherosclerotic risk factors such as hypertension, diabetes, or other cardiovascular risk factors is also possible, but we did not identify any signi cant interactions for hypertension or diabetes. A relation with headache in general7 cannot be excluded. Finally, sex differences seem to play an important role because progression of deep white matter hyperintensities was only found in women. This nding is in line with results from another study8 and consistent with the higher risk of brain infarcts in women with migraine.14 Our sample size was too small for a proper analysis of sex-related differential interaction between migraine and cardiovascular risk factors. Participants in the migraine group with posterior circulation territory infarctlike lesions, however, did have a less favorable cardiovascular risk pro le than those without posterior circulation territory infarctlike lesions. Further research is needed to unravel the pathogenesis and relevance of migraine-related structural brain changes and their possible relation with ischemic events.
White matter hyperintensities have been associated with cognitive de cits in the elderly29,30 and some studies found evidence for worse cognitive performance in individuals with migraine.31-34 We tested memory, speed, and attention35 in all participants at baseline and follow-up and found no signi cant association between deep white matter hyperintensity volume and cognitive dysfunction. Most prior studies were conducted in older participants with larger deep white matter intensity volumes; this cohort is rather young with relatively little volume.7
In summary, in a community-based cohort followed up for 9 years, migraine was associated only with a higher incidence of deep white matter brain changes among women. There were no signi cant associations of migraine with progression of other brain lesions among women, and there were no associations of migraine headache with progression of any brain lesions among men. These ndings 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.
Structural Brain Changes in Migraine
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