Syncope Migraine And Brain Lesions
Many earlier studies evaluated the function of the autonomic nervous system in migraineurs. Studies were mostly performed interictally in clinic-based samples, However findings are inconsistent with reports of either increased or decreased sympathetic or parasympathetic function. Because of these discrepancies, and because previous studies did not address clinical symptoms of ANS failure, including syncope, orthostatic insufficiency and postural tachycardia syndrome , we assessed the prevalence of these entities in migraine using a population-based design.
Do Migraines Cause Brain Lesions
- White matter lesions. White matter is tissue deep in the brain. Itâs made up of mostly nerves, and it plays a big role in your emotions. Getting small white matter lesions is a normal part of aging. Strokes, multiple sclerosis, and Alzheimerâs disease can also cause them. Because they show up on scans as bright white spots, theyâre sometimes called white matter hyperintensities.
- Infarct-like lesions. Your brain needs oxygen and nutrients. If blood flow is restricted or stopped, brain cells die. A small area of dead tissue is called an infarct. For people with migraines, these infarct-like lesions are silent, which means they donât have any symptoms. In older adults, these lesions are tied to the risk of dementia, but this doesnât seem to be the case in people who have migraines.
A review of studies found that people who got migraines were more likely to have white matter and infarct-like lesions than those who didnât. Those who got migraines with aura, or visual symptoms like blind spots, changes in vision, or flashes of light, had the biggest risk.
Getting frequent migraine attacks or a longer history of migraines also raises your chances of getting lesions. Women are more likely to get white matter lesions.
Research: Migraine Headaches Could Indicate Brain Lesions
“It’s characterized by headache and nausea and sensitivity to light and sound,” said Lenore Launer, a senior investigator with the National Institute on Aging.
Researchers from the National Institute on Aging looked at the brains of middle-aged men and women. Some had migraines, some did not.
In a report provided by the Journal of the American Medical Association, study authors found migraine sufferers had a higher risk of having small lesions in the white matter of the brain than those without migraines.
“Particularly among women, there was evidence of an increased risk of having these small white hyper-intensities on the MRI scan,” said Launer.
While the evidence suggests these lesions may be associated with a migraine attack, researchers say there’s no proof these headaches cause the small white hyper-intensities or that they cause any further cognitive or debilitating effects. But Launer plans to do more research to examine the lesions more closely.
“This really changes the game in terms of thinking that migraine is an intermittent condition that does not leave any lasting trace on the brain, to something where it’s a more chronic condition where there actually is some evidence left as a result of the migraine,” said Launer.
But will this affect the way doctors treat migraines? Scientists say not at this point. Patients and doctors should not change how they manage their migraines.
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What The Research Shows
While it’s clear that migraine is a risk factor for developing subclinical brain lesions, the causes, nature, and long-term outcomes are still uncertain and the research is somewhat inconsistent.
As of now, research indicates that the presence of brain lesions seems to be more common in women, especially those who have frequent migraine attacks and who have a long history of migraines. Lesions are also associated more strongly with people who have migraine with aura.
As far as other causes for brain lesions, a 2015 study examined the relationship of cardiovascular risk factors , like smoking, high blood pressure, body mass index , and high cholesterol, to the presence of white matter hyperintensities in migraineurs.
The results indicated that these cardiovascular risk factors weren’t associated with WMH in people with migraine, and other studies have shown similar results.;The authors suggest that the effects of migraine itself may be the direct cause for the brain lesions.
It’s possible that there are other factors involved too. For instance, some scientists recommend studying the relationship between a patent foramen ovale and brain lesions in migraines. A PFO, which is a hole in your heart, is more common in migraineurs with aura and is found in about one-fifth of the population. PFO increases your risk of stroke, as tiny blood clots can travel from the heart through the hole to the brain.
What Are Complications Of Brain Lesions
Although the complications of any brain lesion are numerous and often dire, they are generally related to either the progression of the brain lesion itself or to complications from treatment. Left untreated, many brain lesion types may eventually lead to the development of complications such as for example respiratory depression, loss of muscle function, or widespread brain cell death leading to seizures and coma. Other serious complications include severe disability . Dangerous behavior patterns may occur in some patients, especially those that develop slowly progressive diseases like Alzheimer’s disease.
Complications from attempts to treat various brain lesions can also be severe. A brain surgeon often has to go through normal brain tissue to reach the brain lesion, both for diagnosis and treatment. Complications may include injuring otherwise normal brain tissue, thus making the patient’s symptoms worse. There is a similar risk involved with radiation therapy, as the destructive beam may damage or affect surrounding normal tissue. Chemotherapy, while designed to target specific cancer cells, may also affect some of the bodies other normal cells resulting in cell damage or cell death. Nausea, vomiting, dehydration, weakness, and susceptibility to infection may also result.
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Whats The Link Between Migraines And Brain Lesions
Experts arenât sure why migraines are linked with brain lesions. But these things may play a role:
- Blood clots and shortages. Migraine attacks may lower blood flow and pressure. They can also cause blood vessels to shrink. This sets the stage for tiny blood clots or a lack of blood to certain areas of the brain.
- Tissue damage. During a migraine, the nerves in your brain kind of go haywire. They may work overtime and become inflamed.
- Heart problems. Migraines are linked to two heart conditions: Patent foramen ovale is a hole in the heart. Mitral valve prolapse is when heart valves donât close fully, which may can cause a small leak. Both issues may lead to lesions.
Signs There May Be Inflammation In Your Brain
Inflammation in your body isn’t always a good thing. When you have inflammation in your brain, it can affect anything from your mood to your focus. In case you didn’t know, it can even affect you physically. Knowing the symptoms and potential causes can help you get the right kind of treatment you need.
As neuro-oncologist Santosh Kesari, MD, PhD, tells Bustle, inflammation in the brain can be due to a variety of reasons including toxins in the body like tobacco or cocaine, diabetes, hypertension, infections, trauma, aging, diet, and stress.
“Some inflammation is acute, short-lasting, and potentially reversible, while other types of inflammation are chronic and continue to cause damage,” Dr. Kesari says. “These can be cumulative and not easily reversible such as Alzheimerâs disease.” Some people are also genetically predisposed to brain inflammation by having an overactive immune system like in those with multiple sclerosis or encephalitis, which is a type of acute inflammation in the brain.
According to him, acute or severe inflammation can cause variety of immediate symptoms. At the very worst, it can possibly lead to brain damage, a coma, or even death. It’s just always a good idea to speak to your doctor if you’re ever feeling off.
Inflammation in the brain doesn’t have to be scary. In fact, some symptoms can be fixed through simple lifestyle changes. So here are some signs your brain might be inflamed, according to experts.
Do White Matter Lesions Cause Any Problems
Very often, white matter lesions dont cause any noticeable problems;for the individual. Sometimes, white matter disease, particularly when it is severe, can;interfere with the way the brain works and the processes that it controls, including thinking and walking. This is because the nerve signals cant get through as normal.
Patients With Migraine Are Often Concerned That The Disorder Will Lead To Permanent Damage This Fear Is Exacerbated When A Brain Scan Shows Lesions Dr Peter Goadsby Explains Why This Fear Is Unfounded
Dr. Peter Goadsby is a neurologist, a professor of neurology and director of the NIHR Wellcome Trust at Kings Clinical Research Facility in London, a professor of neurology at the University of California, San Francisco, and will be the president-elect of the American Headache Society. He spoke with AHS to clear up common misconceptions about migraine and long-term brain damage.
Many patients with migraine fear permanent brain damage due to the severity of their head pain. What does your research tell us about the development of brain lesion in migraine patients?
Many of the patients I see with migraine are concerned that the migraine attacks or the disease is causing permanent damage. To the best of our understanding, thats completely wrong. Migraine patients do not have to be worried about long-term brain damage. It simply doesnt happen.
How do you know its wrong, and what can be done to set the record straight?
There are two very good studies which address this problem. One is called the CAMERA Study.
The other big study is called the EVA Study. Its a French population-based study where patients born between 1922 and 1932 were scanned. Their history was taken. They werent examined. They were diagnosed with migraine with and without aura, and of course there were the controls. They had a battery of 10 cognitive tests, including tests of brain function. There was no correlation with the brain changes and any cognitive dysfunction.
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Dispelling Common Misconceptions About The Lasting Effect Of Migraine On The Brain
The intensity of a migraine attack can be so severe, people with migraine sometimes question whether their headaches may be causing permanent damage. While there is evidence that brain scans of people with migraine will sometimes detect changes in the form of white matter lesions, a systematic review of migraine and structural changes in the brain from 2013 indicates that these lesions are generally not associated with any neurological issues, and dont indicate any increased risk of cognitive decline.
Peter Goadsby, M.B., B.S., a neurologist and professor of neurology at the NIHR Wellcome Trust at Kings Clinical Research Facility in London and the University of California, San Francisco, who led the 2013 study and continues to examine migraines lasting neurological effects, says many migraine patients he sees are unnecessarily concerned about long-term brain damage.
To the best of our understanding, thats completely wrong, he says. Theres no association with cognitive function or thinking problems associated with these changes.
A Common Disorder With Long
According to the Migraine Research Foundation, migraine ranks in the top 20 for the worlds most disabling medical illnesses. Every 10 seconds, a person in the US visits the emergency room as a result of a headache or migraine.
For a disorder that is so common, the researchers stress that it is important to understand the long-term effects a migraine can have on the brain.
They add that guidelines from the American Academy of Neurology and the US Headache Consortium suggest that people with migraines who have normal neurological examinations do not need routine MRI scans.
Only patients with atypical headache, a recent change in headache pattern, other symptoms , or focal neurologic symptoms or signs are recommended for MRI of the brain, the researchers say.
Patients with WMAs can be reassured. Patients with ILLs should be evaluated for stroke risk factors. Volumetric MRI remains a research tool.
Dr. Messoud Ashina of the University of Copenhagen and lead study author says that further research is needed to fully determine the link between migraine and long-term brain structure.
Migraine affects about 10 to 15% of the general population and can cause a substantial personal, occupational and social burden, he adds.
We hope that through more study, we can clarify the association of brain structure changes to attack frequency and length of the disease. We also want to find out how these lesions may influence brain function.
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Treatment Of White Matter Lesions Associated With Migraine
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- Bayram, E., et al. . “Incidental white matter lesions in children presenting with headache.” Headache 53: 970-976.
- Brownlee WJ. Misdiagnosis of multiple sclerosis. If you have a hammer, everything looks like a nail ? Editorial. Neurology, 2019;92:15-16.
- Candee, M. S., et al. . “White matter lesions in children and adolescents with migraine.” Pediatr Neurol 49: 393-396.
- De Benedittis, G., et al. . “Magnetic resonance imaging in migraine and tension-type headache.” Headache 35: 264-268.
- Hamedani, A. G., et al. . “Migraine and white matter hyperintensities: the ARIC MRI study.” Neurology 81: 1308-1313.
- Palm-Meinders, I. H., H. Koppen, et al. . “Structural brain changes in migraine.” JAMA 308: 1889-1897.
- Sacco, S. and T. Kurth . “Migraine and the risk for stroke and cardiovascular disease.” Curr Cardiol Rep 16: 524.
- Sprint MIND investigators . “Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions.” JAMA 322: 524-534.
- Toghae, M., et al. . “The Prevalence of Magnetic Resonance Imaging Hyperintensity in Migraine Patients and Its Association with Migraine Headache Characteristics and Cardiovascular Risk Factors.” Oman Med J 30: 203-207.
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Paula: The white matter lesions that occur with each of these attacks, do those need to be investigated with a brain scan or MRI?
Dr. Lipton: The white matter lesions that are associated with Migraine with aura can only be identified by doing MRI. So you don’t know you have white matter problems unless you get an MRI.
And for the most part, when we see whitematter lesions on MRI in someone who has Migraine with aura, we consider that part and parcel of the Migraine with aura process, and it doesn’t really require additional investigation.
I do think that preventive therapies, treatments that reduce attack frequency in people with Migraine, might be more important in people who have aura than in people who don’t because auras are brain events that produce a lot of brain changes, some of which have enduring consequences that we can see on MRI.
Paula: Would you say that the lesions are evidence that’s seen on an MRI, but not necessarily something that requires action beyond the normal prevention that you would do for Migraine?
Dr. Lipton: When people have deep white matter lesions on MRI, that really doesn’t change clinical management in any sort of dramatic way. It does make me think, how many attacks is this person having? Is this a person who might benefit from preventive therapy?
There’s no specific treatment for white matter lesions, and it just might cause me to emphasize preventive treatment approaches a little bit more.
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Focus On Symptoms Not Perceived Risks
Dr. Goadsby says patients are often concerned that brain changes correlate with stroke or cognitive dysfunction later in life. This is not the case, and Goadsby says in fact, the stroke risk for migraine sufferers become less prominent after the age of 45.
Patients with migraine with aura face a small risk of stroke compared to population controls , or patients with migraine without aura, he says. Because of the low risk, Goadsby says migraine patients who have regular normal physical examinations do not need to get regular brain scans. He says that the pain of migraine attacks is the symptom that patients and their care teams should prioritize, not the possibility of lesions or the fear of increased stroke risk. It should also be noted that the presence of these lesions should not influence the use of any particular medication.
Migraine is an inherited episodic brain disease, Goadsby says. It doesnt shorten life: it ruins it. Migraine patients do not have to be worried about long-term brain damage. It simply doesnt happen.
To learn more, visit the American Migraine Foundation, where neurologists like Dr. Goadsby and others share information and resources about the disease, including the various treatment options available to people living with migraine and head pain.
What Causes White Matter Lesions
Lots of different diseases, as well as injuries and toxic substances, can cause damage to the white matter. High blood pressure is a very common cause. Other causes include;diabetes mellitus, high cholesterol;and smoking. Other factors such as genetics are likely to play a role. Sometimes, white matter lesions are caused by inflammation of the brain.
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Comparisons With Previous Studies
Our findings extend our knowledge of the association between headache and white matter hyperintensities to non-migraine headache, which is likely to be tension-type headache, and to older people. Previous population based studies could only evaluate the association between migraine and white matter hyperintensities, showing increased risk. In a meta-analysis of case-control studies, migraine was associated with a fourfold increased risk of white matter abnormalities. For tension-type headache, our data confirm results from a previous small case-control study of 63 patients with chronic primary headache and 54 controls free of headache. This imaging study found that the prevalence of white matter abnormalities was similar for tension-type and migraine headaches and both were increased compared with controls .
Our results of a strong association between migraine with aura and deep white matter hyperintensities extend the findings of the Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis study. In this population based sample of men and women aged 20 to 60 years from the Netherlands, overall migraine was associated with an increased load of deep white matter hyperintensities among women but did not differ according to migraine aura status. The association was stronger with higher frequency of migraines, information that was not available in our study.