It’s common to worry that Migraine will contribute to more serious health problems. Even if we’re not having a Migraine attack, the headlines reporting links between Migraine and several serious health problems may keep us awake at night.
Often, the truth is not a frightening as the headlines claim. To put our minds at ease, we’ll need to know more than a 30-second soundbite can offer. The truth is usually more complicated and less frightening. Shining a light on our worst Migraine nightmares can help us understand the risks. Armed with the facts, we can then work with our doctors to minimize our risk factors. Let’s put a stop to those Migraine nightmares and finally get some sleep.
Our worst Migraine nightmares
- White matter lesions
- Brain tumor
- Stroke
- Heart attack
- Parkinson’s
- Cognitive decline
Let’s shine a little light on these nightmares and discover the truth. For starters, remember that most of these nightmares apply only to those who have Migraine with aura. The prevalence of Migraine with aura is 25 to 30 percent of all Migraine patients. That’s good news for the 60 to 75 percent of patients who never experience aura. For those who do experience aura, there’s still good news.
Association, not causation
In almost every case, these nightmares have been shown only to have an association with Migraine. That means that they are comorbidities and not caused by Migraine. There is no reason to fear that Migraine itself will cause most of these.
1. White matter lesions
White matter lesions do appear to be caused by Migraine. They are present in 63.4 percent of Migraine patients, with and without aura. However, there is a correlation between the duration of aura and the number of white matter lesions. At this point, there have been no reports of symptoms resulting from these lesions.
Some patients have reported that their MRI reports have noted these lesions and suggested a possible diagnosis of multiple sclerosis (MS). While alarming, Migraine specialists are trained to distinguish the benign white matter lesions from those present in MS.
2. Brain tumor
This is also one of the least likely of the nightmares to truly be a threat. The March 2015 issue of Headache published a study concluding that brain tumor is not a long-term consequence of Migraine. Additionally, the study noted that the headache symptoms of a brain tumor are not consistent with the symptoms associated with Migraine.4 In most cases, Migraine doctors will order an MRI to rule out other problems prior to diagnosing Migraine.
3. Stroke
There’s plenty of evidence that Migraine with aura increases stroke risk. A January 2017 study published in BMJ also concluded that people with Migraine are at increased risk of peri-operative stroke.11
That may sound alarming until you understand that the actual risks are:
- 2.4 per 1,000 in the general population
- 3.9 per 1,000 in Migraine without aura
- 6.3 per 1,000 in Migraine with aura
If you have Migraine with aura, it also makes sense to talk to your doctors about minimizing risk factors, for stroke, which include:
- High blood pressure
- High cholesterol
- Oral contraception
- Cigarette smoking
- High sodium intake
It also makes sense to inform your surgeon and anesthesiologist that you have Migraine prior to an operation so they can take necessary precautions during surgery to reduce any risks.
4. Heart attack
People with Migraine with aura are 2.08 times more likely to have a heart attack than the general population. No increased risk has been demonstrated in people with Migraine without aura. The general agreement among Migraine experts is that Migraine with aura and cardiovascular disease may share a genetic link.1,3,10
If you have Migraine with aura, it’s a good idea to talk to your doctors about minimizing your risk factors for heart attack. These include:
- High blood pressure
- High cholesterol
- Oral contraception
- Cigarette smoking
- High sodium intake
- Inactivity
- Diabetes
- Obesity
5. Parkinson’s
According to a study published in the September 2014 issue of Neurology, the presence of Migraine with aura in midlife is associated with a 2.4 percent risk of developing Parkinson’s in late life, compared with a 1.1 percent risk in the general population. Possible reasons for the association may include other shared factors:
- Dopamine dysfunction is present in both.
- Restless leg syndrome is comorbid to both.
- Head injury is a known risk factor for both.
- Stroke is associated with Migraine and is a risk factor for Parkinson’s.7,9
Many of the risk factors for Parkinson’s are non-modifiable. Still, it is important to recognize the true risks for the sake of being informed, rather than fearful. Keep in mind that, at most, the relative risk is 2.4 percent. It’s not as if a large percentage of people with Migraine are guaranteed to develop Parkinson’s.
Here are the major risk factors for Parkinson’s:
- Migraine with aura present in mid-life
- History of restless leg syndrome
- Family history of Parkinson’s
- Being over age 60
- Being male
Even if you are at risk, there are steps you can take to lower it:
- Follow the CDC guidelines to protect against concussion and other head injuries.2
- Manage stroke risk factors.
- Limit exposure to herbicides and pesticides.5
6. Cognitive decline
Many people with Migraine express concerns about memory loss, inability to concentrate, other cognitive impairments, or that Migraine will cause permanent cognitive damage. It should come as a relief that, according to a 2013 literature review in Headache, people with Migraine of any type are not at increased risk for cognitive decline.6,8 Peter Goadsby, MD, the headache specialist who led this study remarks,
“Sadly, we all get a little bit less cognitively aware, you might say, with time,” Goadsby says. “But there’s no difference between migraine patients and those without migraine. When you look at the population-based evidence, the really good studies, there is no good evidence that those changes in the brain are even lesions, because they don’t cause anything, and there is no evidence at all that migraine does excess damage to the brain.”
Temporary, reversible cognitive impairment is common during attacks and as a side effect of some commonly prescribed medications. It’s important to address any concerns about cognitive abilities with our doctors.
Sources
- Bigal M, Kurth T, Santanello N, et al. Migraine and cardiovascular disease: A population-based study. Neurology. 2010;74(8):628-635. doi:10.1212/WNL.0b013e3181d0cc8b.
- Brain Injury Safety Tips and Prevention, Centers for Disease Control and Prevention (CDC). 14 Mar 2017.
- Kurth T, Gaziano M, Cook N, et al. (2006). Migraine and Risk of Cardiovascular Disease in Women JAMA: The Journal of the American Medical Association. 2006;296:283-291.
- Kurth T, Buring J, Rist P (2015). Headache, migraine and risk of brain tumors in women: prospective cohort study. The Journal of Headache and Pain. 2015;16(1):17. doi:10.1186/s10194-015-0501-0.
- Lakhan S, Avramut M, Tepper, S. Structural and Functional Neuroimaging in Migraine: Insights from 3 Decades of Research. Headache. 2013;53:46-6
- Migraine and Brain Lesions, American Migraine Foundation, 9 May 2018.
- Parkinson’s disease, Mayo Clinic. 30 Jun 2018.
- Rist P, Kurth T. Migraine and cognitive decline: A topical review. Headache. 2013 Apr; 53(4): 589–598; doi: 10.1111/head.12046.
- Schürks M, Zee R, Buring J, et al. Interrelationships among the MTHFR 677C>T polymorphism, migraine, and cardiovascular disease. Neurology 2008;71:505-513.
- Timm F, Houle T, Grabitz S, et al (2017). Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ 10 Jan 2017;356:i6635; doi: https://doi.org/10.1136/bmj.i6635