Migraines are more than just painful. Prof Franz Fazekas (University Hospital Graz, Austria), explained why at the 23rd Meeting of the European Neurological Society (ENS) in Barcelona: “Recent studies indicate that these pain attacks also pose an increased risk of vascular lesions in the brain in certain categories of patients. MRI scans show that migraine patients exhibit more frequent changes in cerebral white matter (“substantia alba”) than people without migraine. We therefore investigated whether there are striking changes in cerebral white matter amongst elderly migraine patients in particular and whether migraines might be a possible factor for early mental deterioration.” About 3,000 experts are discussing current developments in the field at this congress right now.
Prof Fazekas is part of the “Leukoaraiosis and Disability” (LADIS) European Research Group. The LADIS Study Group is conducting an in-depth investigation to determine the extent to which changes to white matter gradually result in independent elderly people becoming disabled and dependent on care. Prof Fazekas: “The welcome result of the study was this: We can say for elderly patients at least that their migraines do not increase the risk of vascular injuries in cerebral white matter. They are also not at risk of these pain attacks exacerbating vascular lesions in the brain.”
The study involved 639 people averaging 74 years of age who had sought medical assistance due to slight neurological, cognitive or motor conditions or for whom magnetic resonance imaging taken because of unspecific complaints happened to reveal changes to white matter. The study subjects were evaluated on the basis of a comprehensive clinical, neuropsychological and functional protocol at the start of treatment and then annually after that over a period of three years. In the first examination, they were asked particularly about a possible history of migraines. In addition, an MRI scan was also conducted at the beginning and end of the study period. The volume and degree of severity of changes to white matter was determined during these scans and the progression of the changes was documented.
Migraines do not act as catalysts
Amongst the study participants, 16% (103 subjects) suffered from migraines. Most of them (68) had migraines without aura. There were three times more women suffering from these torturous headaches than men (78 versus 25). The degree of severity and volume of changes in white matter was the same with all subjects in the study at the beginning of treatment regardless of whether they were migraine patients or not. Prof Fazekas: “The follow-up examination after three years revealed no significant correlation between migraines and the progression of changes in white matter. No gender-specific differences were detected, either. In short, the assumed correlation between headaches and neurological changes was not confirmed. Our findings indicate that the correlation between migraines and changes in white matter is a specific phenomenon amongst affected younger people and presumably attributable to some other pathogenic mechanism. Further studies covering a larger random sample of the general population are needed to clarify the correlation between migraines and vascular diseases in the brain.
The small white cells
White matter is the name for the component of the central nervous system comprising numerous axons. These axons are ensheathed with a layer of whitish fat, which renders them extraordinarily conductible. Cerebral white matter accounts for more than half the brain mass in human beings. It serves as an indispensable connection centre because it shorts-circuits different areas of the brain, some of which are far apart. White matter has long been overshadowed in science by grey matter because the latter is associated with the mental operations involved in thinking and acting. However, white matter is crucial for how the brain functions, for successful learning and for social behaviour.
23rd Meeting of the European Society of Neurology (ENS) 2013.
ENS Abstract O268: White matter changes and migraine in elderly subjects. Results of the LADIS study
European Neurological Society