White Matter Lesions and migraines

So I recently discovered I have these migraine brain lesions. Not because I was told, but because I read the letter he sent to my doctor where he said “scan from July 2009 had minimal scattered lesions.”

I suspected as such when my pain doc said he could ‘see’ I had migraines after reviewing my files and that old MRI. I knew you cannot see anything of the sort, other than damage due to stroke, therefore I very likely had some lesions showing at that time.

The research is as interesting as it is confounding. What is going on? Why is it going on? Is there any long term damage from the accumulation of these lesions? Are there any other structural changes going on with the brain we are unaware of? (such as with other forms of chronic pain some atrophy can be seen in certain areas). It puzzles me. Nevertheless is is damage for the migraines. And that is disturbing in itself.

This research in 2011:

 the dBrain white matter hyperintensities are more prevalent in migraine patients than in the general population, but the pathogenesis and the risk factors of these hyperintensities are not fully elucidated. The authors analyzed the routine clinical data of 186 migraine patients who were referred to the Outpatient Headache Department of the Department of Neurology, Medical School, University of Pécs, Hungary between 2007 and 2009: 58 patients with white matter hyperintensities and 128 patients without white matter hyperintensities on 3 T MRI. Significant associations between the presence of white matter hyperintensities and longer disease duration (14.4 vs. 19.9 years, p = 0.004), higher headache frequency (4.1 vs. 5.5 attacks/month, p = 0.017), hyperhomocysteinemia (incidence of hyperintensity is 9/9 = 100%, p = 0.009) and thyroid gland dysfunction (incidence of hyperintensity is 8/14 = 57.1%, p = 0.038) were found. These data support the theory that both the disease duration and the attack frequency have a key role in the formation of migraine-related brain white matter hyperintensities, but the effects of comorbid diseases may also contribute to the development of the hyperintensities.NCBI

At the bottom you can note that study determined disease duration and attack frequency were factors.

Research 2008

Study Results

  • Study Migraineurs with a high frequency of Migraine (more than three attacks per month) showed significantly more abnormalities than those with fewer attacks.
  • Study Migraineurs with a history of Migraines longer than 15 years were found to have more changes in the brain than those with a shorter history.
  • Predilection sites (sites with a higher likelihood) of damage to the brains of Migraineurs were identified in the:
    • frontal lobe
    • limbic system
    • parietal lobes
    • brainstem
    • cerebellum

Study Conclusions Healthcentral

  • Both the frequency of Migraine attacks and the length of history of Migraines are indicators for brain damage in Migraine.

  • Attack frequency and disease duration have an influence on brain structure and integrity in Migraineurs.

  • Migraineurs with higher frequency of Migraine attacks showed abnormalities in both white matter and grey matter of the brain.

  • The frontal lobe was shown to be one of the most prominent areas of brain abnormalities in Migraineurs.

  • High frequency of Migraine attacks or a long history of the disease might contribute to accumulating brain damage due to the repetitive occurrence of pain-related processes, thus making Migraine a progressive disease.

 

Research 2012

“After 9 years, there was an increase of lesions selectively in migraine patients, but the fact that this is not related to the frequency or the type of headache, etc., makes it less worrisome. Patients needn’t be concerned that each attack could cause damage to the brain.”

The study results may not shed any more light on cerebral vascular changes in migraine, said Dr. Kurth.

“We don’t really fully understand what white matter hyperintensities mean. One hypothesis is that they show pathologies of smaller vessels. However, it does not necessarily help in understanding the association between migraine with aura and stroke, as here, aura does not seem to play such a strong role, and many strokes in previous studies were not related to small vessel pathologies. “

Dr. Kurth also agreed that the findings should not have any effect on clinical practice.

“We need to understand what these changes in the white matter mean for patients with migraine before we call for changes in clinical practice or give advice to patients. I judge this as an important research finding that calls for further targeted research,” he said.Medscape

In other words, they simply do not know the role they play, if any really. It is clearly an indication we have a neurological disease since there is actual damage and changes to the brain after duration and frequency. So I shouldn’t be surprised, in 2009, I was showing indications of this as I had already been chronic for many years and had migraines for about 12 years at that point.

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