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Migraine headache in middle age and late-life brain infarcts
JAMA, 06/25/09

Scher AI et al. – Migraine with aura in midlife was associated with late-life prevalence of cerebellar infarct-like lesions on MRI. This association was statistically significant only for women. The finding supports the hypothesis that migraine with aura in midlife is associated with late-life vascular disease in the cerebellum and in women.

• Study of whether pts not reporting headache vs pts reporting migraine symptoms, particularly aura, in midlife are at increased risk of late-life infarct-like lesions found on magnetic resonance imaging (MRI) without consideration of clinical symptoms
• Population-based study of 4689 men and women in Reykjavik, Iceland (cohort born 1907-1935; 57% women)
• Follow-up since 1967, examination, and interview about migraine symptoms in midlife (mean age, 51 yrs; range, 33-65 yrs)
• Brain MRIs between 2002-2006
• Pts reporting ≥ 1 headache/mo asked about migraine symptoms: nausea, unilateral location, photophobia, visual disturbance, numbness
• Classification of pts with headache: migraine without aura, migraine with aura, or nonmigraine headache
• Comprehensive cardiovascular risk assessment at both examinations
• Main outcome measure: presence of infarct-like lesions (total) and specifically located in cortical, subcortical, and cerebellar regions

• Infarct-like lesions in 39.3% of men and 24.6% of women
• On adjustment for age, sex, and follow-up time, increased risk of late-life infarct-like lesions for pts with midlife migraine with aura (361)vs pts not reporting ≥ 1 headache/mo (3243)
• This finding specifically reflects an association with cerebellar lesions in women
• Migraine without aura and nonmigraine headache not associated with increased risk

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