Understanding Migraine-Related Brain Lesions on Your MRI

MRI brain changes from migraines are not something you should worry about now

Brain Lesions Showing Up On MRIs of Migraineurs
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Research indicates that migraines are associated with lesions deep within the white matter of the brain, as seen on a magnetic resonance imaging (MRI) scan. These migraine-related brain lesions may or may not have a long-term effect on a person's health. Experts simply do not know at this time — so right now, doctors are not worrying too much about them, until more is known of their relevance.

That being said, research looking into the potential effect of these lesions on a person's migraine and overall health is important, not only for the future of migraine therapy, but also to provide further insight into the brain mechanism behind migraines.

 

Migraines and the Brain

We know that a migraine can precipitate a stroke (although rarely), and this is called a migrainous infarction or migraine-induced stroke. Likewise, migraine with aura is a risk factor for stroke in certain people, especially women and those who smoke, have high blood pressure, or take birth control pills.

In addition, scientists have found that those with migraines have an increased chance of having brain lesions that resemble those of stroke. These lesions are known as white matter hyperintensities or silent infarct lesions. on an MRI. They are called "silent" because they are not linked to any stroke-like symptoms, and "infarct" because they are considered to be ischemic, meaning representing a lack of blood flow. 

Experts have tried to piece together the precise cause of these brain lesions, meaning whether it's the migraine itself or some other factor that migraineurs have.

Research indicates that the presence of these lesions may be more common in women, especially women who suffer frequent attacks and who have a long history of migraines. On the other hand, whether or not a person takes medicine for their migraines does not appear to be associated with these lesions.

In terms of other causes for brain lesions, a 2015 study in Oman Medical Journal examined the relationship of cardiovascular risk factors (factors that increase a person's chance of having a stroke or heart attack), like smoking and high cholesterol, to the presence of these white matter hyperintensities in migraineurs. Results indicated that these cardiovascular risk factors did not make them more likely. 

This hints that potentially the actual migraine is the direct cause for the brain lesion. Or, there may be other factors involved. For instance, some scientists recommend examining the relationship between a patent foramen ovale, or PFO, and brain lesions in migraines. A PFO (a hole in the heart) is more common in migraineurs with aura and is found in about one-fifth of the population. PFO increases a person's risk of stroke, as tiny blood clots can travel from the heart through the hole to the brain. 

What Does Having Silent Infarct Brain Lesions Mean for Me?

We don't really know the significance of these brain lesions yet.

A number of studies have examined  older people who do not have migraines, but have similar lesions (white matter hyperintensities), and these lesions were associated with an increased risk of stroke, dementia, and thinking problems.

On the other hand, a 2012 study in JAMA found that while female migraineurs (not male) had a higher incidence of white matter hyperintensities over a period of nine years compared to a control group, they did not have poorer cognitive functioning. This indicates that these brain lesions may in fact mean nothing health-wise, which is reassuring news. 

That being said, if migraines and their associated brain lesions do have long-term neurological effects, this may alter the way neurologists treat episodic migraines. For example, neurologists may consider migraine preventive medication for episodic migraines in certain people who are at a high risk for developing brain lesions or who already have brain lesions — it's really hard to say at this time. 

The Bottom Line

We really don't know if brain lesions have any health implications, and so at this time, worrying about it is not going to do you much good. Instead, remain steadfast in your migraine health by following regularly with your doctor, taking your medication as prescribed, and monitoring your triggers. Long-term studies that examine the presence and progression of these brain lesions in light of a person's neurological function over time will be helpful.

Sources:

Kruit, M.C., van Buchem, M.A., Launer, L.J., Terwindt, G.M., & Ferrari, M.D. (2010). Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia, Feb;30(2):129-136.

Palm-Meinders, I.H., et al. (2012). Structural brain changes in migraine. JAMA, Nov 14;308(18):1889-97.

Schürks, M., et al. (2009). Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ, 339:b3914.

Toghae, M., Rahimian, E., Abdollahi, M., Shoar, S., & Naderan, M. (2015). The prevenalence of magnetic resonancy imaging hyperintensity in migraine patients and its association with migraine headache characteristics and cardiovascular risk factors. Oman Medical Journal, May;30(3):203-7.

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