Migraine and structural changes in the brain
A systematic review and meta-analysis
Abstract
Objective:
To evaluate the association between migraine without aura (MO) and migraine with aura (MA) and 3 types of structural brain abnormalities detected by MRI: white matter abnormalities (WMAs), infarct-like lesions (ILLs), and volumetric changes in gray and white matter (GM, WM) regions.
Methods:
PubMed as well as the reference lists of identified studies and reviews were used to identify potentially eligible studies through January 2013. Candidate studies were reviewed and eligible studies were abstracted. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for WMAs and ILLs.
Results:
Six population-based and 13 clinic-based studies were identified. The studies suggested that structural brain changes, including WMAs, silent ILLs, and volumetric changes in GM and WM regions, were more common in migraineurs than in control groups. The results were strongest for MA. The meta-analysis of WMAs showed an association for MA (OR 1.68; 95% CI 1.07–2.65; p = 0.03) but not for MO (OR 1.34; 95% CI 0.96–1.87; p = 0.08). The association of ILLs was greater for MA (OR 1.44; 95% CI 1.02–2.03; p = 0.04) than for MO, but no association was found for MA (p = 0.52) and MO (p = 0.08) compared to controls.
Conclusion:
These data suggest that migraine may be a risk factor for structural changes in the brain. Additional longitudinal studies are needed to determine the differential influence of migraine without and with aura, to better characterize the effects of attack frequency, and to assess longitudinal changes in brain structure and function.
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Information & Authors
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Copyright
© 2013 American Academy of Neurology.
Publication History
Received: January 9, 2013
Accepted: July 1, 2013
Published online: August 28, 2013
Published in issue: October 1, 2013
Disclosure
A. Bashir reports no disclosures. R. Lipton receives research support from the NIH [PO1 AG03949 (Program Director), RO1AG025119 (Investigator), RO1AG022374-06A2 (Investigator), RO1AG034119 (Investigator), RO1AG12101 (Investigator), K23AG030857 (Mentor), K23NS05140901A1 (Mentor), and K23NS47256 (Mentor)], the National Headache Foundation, and the Migraine Research Fund; serves on the editorial board of Neurology®; has reviewed for the NIA and NINDS; holds stock options in eNeura Therapeutics; and serves as consultant, advisory board member, or has received honoraria from Allergan, American Headache Society, Autonomic Technologies, Boston Scientific, Bristol Myers Squibb, Cognimed, Colucid, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, MAP, Merck, Nautilus Neuroscience, Novartis, NuPathe, Pfizer, and Vedanta. Dr. S. Ashina received honoraria for lecturing from Allergan and Neurogesx and is a consultant for Depomed. Dr. M. Ashina is an associate editor of Cephalalgia and is a consultant or scientific adviser for Autonomic Technologies, Inc., Allergan, Amgen, and Alder. Go to Neurology.org for full disclosures.
Study Funding
Supported by the Lundbeck Foundation and the Novo Nordisk Foundation.
Authors
Author Contributions
Dr. Bashir and Dr. M. Ashina conceived and designed (including search strategies) the review. Dr. Bashir did the literature search and wrote the first and subsequent drafts of the manuscript. Dr. S. Ashina conducted the meta-analysis. Dr. Lipton, Dr. S. Ashina, and Dr. M. Ashina participated in critical revision and writing of the article. All authors have seen and approved the final version.
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