Migraine: Aura nibbling at the Cerebellum

31. August 2009

Suffering  from migraine is punishment abundant enough. Migraine patients whose pain attacks are heralded by an aura – mostly visual disturbances – might get problems of an even different nature because their type of migraine is associated with brain lesions.

About eleven percent of the adults are afflicted with migraine. Mainly women suffer from it. In about one third of all cases, an aura heralds the evil. This aura might consist of different neurological symptoms such as disorders of sensorics, balance or speech before the pain starts, mainly visual disturbances. Migraine is considered an episodic condition without long-term consequences.

Actually two recent studies suggest that this disorder, especially in conjunction with occurring aura may cause consequences. For example MRI-examinations demonstrated that women in their midlife suffering from migraine with aura showed brain lesions in late-life, something patients with other types of headache did not show. Results were published in the Journal of the American Medical Association. Lesions were mainly located in the cerebellum.

Cerebellum lesions in women

Ann Sher at the Uniformed Services University in Bethesda, Maryland/USA, and colleagues studied the relations between migraine symptoms in midlife and infarct-like brain lesions occurring in late-life in 4,689 men and women being part of the Age Gene/Environment Susceptibility-Reykjavik Study (AGES-RS), cohort born between 1907 and 1935. More than 26 years later the physicians performed brain-MRIs, interviews regarding headaches and a comprehensive cardiovascular risk assessment.

The MRI showed infarct-like lesions in 39.3% of men and 24.6% of women reporting migraine attacks once or more per month. After adjusting for age, sex, and follow-up time
those with midlife migraine with aura had an increased risk of late-life infarct-like lesions (odds ratio 1.4). It specifically reflected an association with cerebellar lesions in women, a prevalence of infarcts 23.0% for women with migraine with aura vs. 14.5% for women not reporting headaches. After consideration of the cardiovascular risk female migraine patients with aura were not associated with an increased risk (odds ratio 1.9).

Modifiable risk factor?

But US-researcher Marcelo E. Bigal at the Albert Einstein College of Medicine in New York/USA and his colleagues came up with different results concerning cardiovascular risk factors in migraine patients. In their review published in the professional magazine Neurology they assume that cortical spreading depression, the presumed substrate of aura, may directly predispose to ischemic brain lesions. Migraine patients in general and those with aura in particular are associated with increased cardiovascular risk factors such as ischemic strokes and other ischemic CVD events are more likely to occur.

Accordingly, heightened vigilance is recommended for modifiable cardiovascular risk factors in migraine patients, especially those with aura. It will be relevant to determine whether migraine with aura itself is a modifiable risk factor for cardiovascular disorders and if preventive medications for migraine such as antiplatelet therapy might reduce the risk – an issue for further studies.

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