Does migraine damage the brain?

A frequently asked question

Does migraine damage the brain? This is an enquiry often received at The Migraine Trust, especially following stories appearing in the media that raise questions about whether migraine can cause harmful changes in the brain, so we asked our medical Trustees for some help in interpreting the research.

Migraine research sometimes includes the use of imaging technology, or scans, to examine the brain structure and compare the brain of migraine sufferers with those who are not sufferers. Therefore, trying to understand whether there are differences in the structure of the migraine brain might help in developing new and more effective treatments for migraine.

In a paper by Dr A Bashir and others, the authors reviewed 19 earlier studies, 13 of which were studies of people who attended migraine clinics. Compared with non-migraineurs, those with migraine with aura (but not those with migraine without aura) had a small but statistically significant increased appearance of white-matter abnormalities. Infarct-like lesions were statistically more common in people with migraine with aura than in those who had migraine without aura. However, reassuringly, these were no more common in either group of migraineurs than in the people without migraine. The research shows that people who have migraine without aura are not at any important risk for either white-matter abnormalities or infarct-like lesions compared to people without migraine. In addition, there are no cognitive (thinking) problems caused by migraine or by having an MRI scan similar to those in the studies. The research shows that current recommended treatment for migraine does not need to be changed, and that there is no need for scans for those who have a definite diagnosis of migraine with no unusual symptoms. Unusual symptoms that raise concern and warrant further investigation like an MRI scan, are usually picked up when the doctor does a neurological examination.

People with migraine also had more volume in some parts of their brain, and less volume in other parts of their brain, compared to people without migraine. The differences in volume that were seen in different parts of the brain seem to be static, that is, not something that appears to be progressive or caused by migraine attacks. Again, there are no cognitive consequences or implications for the treatment of migraine, based on what is currently known. However, much more research is needed before any further interpretation could be made and these findings may simply mark the inheritance of migraine.

Professor Peter Goadsby, Director of the NIHR-Wellcome Trust Clinical Research Facility at King’s College Hospital, London, and Trustee of The Migraine Trust, believes that resolving these types of questions is hugely important and will require a well-funded, large-scale, population-based imaging study.

"To understand what happens with time to the human brain in health and disease would be a wonderful legacy for the next generation." Professor Peter J Goadsby

References

  • Goadsby, P.J. Migraine and structural changes in the brain. NEJM Journal Watch. September 19th 2013.
  • Bashir, A. et al. Migraine and structural changes in the brain: a systematic review and meta analysis. Neurology. October 1st 2013 81 (14) 1260-8. Epub August 28th 2013.

Information taken from Migraine News journal, Issue 109, March 2014.