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Study Links MidLife Migraines to Late-Life Brain Infarcts: Presented at ANA

By Jacquelyn Beals

WASHINGTON, DC -- October 9, 2007 -- An international group of researchers has found evidence of an association between midlife migraines and a higher risk of ischemic stroke.

Senior author Lenore J. Launer, PhD, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland, United States, collaborated with scientists in Iceland, the Netherlands, and the United States, to investigate the relevance of midlife migraines to future stroke risk.

Dr. Launer presented the poster here at the American Neurological Association (ANA) 132nd Annual Meeting. She noted that this relationship between migraine and stroke risk among participants in the Reykjavik Study has "not been examined in a prospective study."

The participants (born between 1907 and 1935) were assessed for headache symptoms during midlife -- when participants were a mean age 50 years. Subjects who reported one or more headache/month were asked to characterise their headache symptoms: accompanied by nausea or vomiting; one-sided; involving light sensitivity; visual disturbance during or preceding headache (aura); or unilateral numbness before headache (sensory aura). The presence of three or more of these symptoms defined migraines. Cardiovascular risk was also assessed in this midlife population.

Midlife migraines were reported in 5% of male and 18% of female participants. Migraines with visual auras occurred in 4% of men and 10% of women. Dr. Launer mentioned that the greater frequency of migraines in females is clinically valid. However, the occurrence in 5% of men refutes the image of migraines as primarily limited to women.

In 2002, the participants were asked to join the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study. Complete data were obtained for 1,843 participants who were 60 years of age at the time of the midlife examination. An average of 25 years after their midlife assessment the researchers acquired full brain magnetic resonance imaging scans of participants -- when they were a mean age of 76 years. Radiographers scanned for infarcts in subcortical, cortical, and cerebellar regions.

Regression analysis estimated the risk of late-life infarcts in participants with and without midlife migraine symptoms. The study included separate analyses for men and women, and for subjects who were younger than 50 years and older than 50 years.

While sex and age had no significant effect on the risk outcomes, midlife migraines with or without aura had a significant association with cortical infarcts (odds ratio [OR]=1.81 [1.1-3.0], P <.02), but not with infarcts in other locations, or infarcts overall.

Limiting the analysis to headaches with visual aura, the investigators identified a significant association with late-life cerebellar (OR=1.82 [1.1-2.9], P <.01), cortical (OR=2.35 [1.3-4.2], P <.005), and total (OR=1.65 [1.1-2.5], P <.02) infarcts. No significant relationships were found between infarcts and midlife headaches with sensory aura, or both sensory/visual auras.

The authors concluded that individuals who experience midlife headaches with a visual aura have an increased risk of cortical and cerebellar infarcts in old age (25 years after headache reports). Cardiovascular risk factors measured in midlife did not explain this relationship.


[Presentation title: Migraine in Mid-Life Predicts Brain Infarcts in Old Age: A Longitudinal Population-Based MRI Study. Abstract M-66]

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