SEATTLE—Middle-aged women with migraine have an increased risk of cerebellar infarct-like lesions 25 years after initial headache diagnosis, according to study results presented at the 61st Annual Meeting of the American Academy of Neurology. The findings were also published in the June 24 JAMA.
Ann I. Scher, PhD and colleagues observed the relationship between migraine and infarct-like lesions by following up a population-based study conducted in Reykjavik, Iceland (n = 4,689; 57% women), in 1967. Subjects were interviewed about headache symptoms in the Reykjavik Study about 26 years prior to receiving brain MRI in 2002 to 2006 as part of the Age Gene/Environment Susceptibility (AGES)-Reykjavik Study. Midlife (mean age, 50) and late-life (mean age, 76) assessments were completed.
“The relationship between age and prevalence of these conditions is quite different,” stated Dr. Scher, Associate Professor of Epidemiology in the Department of Preventive Medicine and Biometrics, Uniformed Services University in Bethesda, Maryland. “Cross-sectional studies in middle age may capture individuals who are still getting migraines but who are at low risk for stroke,” Dr. Scher continued. “Studies of older populations who have a higher risk for stroke may no longer be having migraine symptoms, and may not recall them accurately.”
Participants who reported headaches once or more per month were surveyed about the presence of migraine symptoms, including nausea, unilateral location, photophobia, visual aura, and sensory aura. Presence of cortical, subcortical, cerebellar, and total infarct-like lesions were the main outcome measure.
“In this elderly population, infarct-like lesions were present in 39.3% of men and 24.6% of the women,” researchers stated. After adjusting for age, sex, and follow-up time, subjects with a remote history of migraine with aura (n = 361) had a greater risk of late-life infarct-like lesions (adjusted odds ratio [OR], 1.4), compared with those who did not report headaches once or more per month in midlife. “This mainly reflects the risk associated with lesions located in the cerebellum (adjusted OR, 1.6),” Dr. Scher and authors commented.
Cerebellar infarcts were present in 23% of women with midlife migraine with aura, compared with 15% of women without headache (adjusted OR, 1.9). “The relationship between midlife migraine with aura and cerebellar infarcts was only significant in women (men, adjusted OR, 1.0 vs women, adjusted OR, 1.9, for interaction by sex), but was not statistically different by the age at which headache symptoms were assessed (age 50, adjusted OR, 1.4 for interaction by age),” Dr. Scher and colleagues noted.
Results of secondary analyses adjusting for measures of cardiovascular risk, coronary heart disease, and diagnosed transient ischemic attack/stroke history in late-life were similar and unchanged. Separate analyses for visual and sensory aura suggested that the association of cerebellar infarcts with migraine with aura in women was stronger for visual aura (adjusted OR, 2.2) than for sensory aura (adjusted OR, 1.3).
These results suggest that “the mechanism linking the migraine aura with these lesions is independent of the usual risk factors for ischemic vascular disease and may be specifically related to migraine with aura,” Dr. Scher and investigators commented. They added that “the clinical relevance of these lesions is presently unclear and warrants further investigation.
—Laura Sassano