FINAL REPORT: Migraine in Middle Age and Late Life: A Longitudinal Analysis of Factors Related to Migraine Prognosis in a Large Population-Based Cohort

Published in the Journal of the American Medical Association, Volume 301, Issue 24, June 2009

Summary

About one third of migraine sufferers experience transient neurological disturbances during or just before attacks (migraine with aura). There has been considerable interest in recent years regarding the evident increased risk of clinical and sub-clinical cardiovascular disease in migraine sufferers with aura. In this study, we were interested in whether adults with migraine in middle age were at increased risk of stroke-like lesions or white-matter lesions on MRI in later life. We were also interested in whether migraineurs with a certain genetic make-up were particularly at risk for these cardiovascular outcomes. Our study population is a unique population-based cohort of adults in Reykjavik, Iceland who have been followed for more than 25 years.

We found that the migraineurs who reported aura symptoms in middle age were more likely than others to have stroke-like lesions in the cerebellum.

Hypotheses vs. Findings

Some of our findings were consistent with our hypotheses and some were not. For example, the only other study that considered this question (Kruit et al, JAMA 2005) also found that the relationship between migraine and these lesions was only evident for individuals with migraine with aura and was strongest for lesions located in the cerebellum. In addition to confirming these earlier results, we also found that the risk appeared to be evident only for women – which was interesting and needs to be confirmed in other studies. In secondary analyses, we also found a suggestion that migraine may be related to cortical lesions in men.

Unanswered Questions

While the epidemiologic relationship between migraine with aura and clinical and sub-clinical cerebrovascular disease appears increasingly solid, the degree to which these infarct-like lesions have clinical consequences is uncertain. It is possible that people who experience migraine with aura over their lifetimes may have associated subtle problems with, for example, balance in their later years. It is also possible that these lesions are not at all associated with functional consequences. In either event, what these lesions – and even the migraine aura itself – represent is a question of scientific and public health interest.

What this Research Means to You

We found that migraine sufferers who experienced auras, especially women, were more likely than others to have small stroke-like lesions in the cerebellum part of their brain. Future research will help to establish whether these lesions mean something and, if so, whether reducing attack frequency might help to prevent them.

Learn More

Though a latecomer to the field, Ann Scher, PhD has had a significant impact on migraine research. Dr. Scher has devoted her second career to studying the prevalence and risk factors for migraine and other headache disorders with the goal of improving the quality of life of headache sufferers. MRF recognized her important work by awarding one of its first research grants to her study Migraine in Middle Age and Late Life: A Longitudinal Analysis of Factors Related to Migraine Prognosis in a Large Population-Based Cohort. The results of this study were recently published in the Journal of the American Medical Association.

The JAMA paper examined the relationship between migraine in middle age and late-life stroke-like lesions. This study is important because it expands on earlier research showing links between the two and may provide a better understanding of how migraines and aura affect the brain.

As Associate Professor of Epidemiology at Uniformed Services University, a medical and graduate school for active-duty military personnel, Dr. Scher teaches epidemiology methods to the University’s public health students.

Dr. Scher also studies post-traumatic headache in military service members.  She hopes to better characterize post-traumatic headache and determine the factors that affect the likelihood of developing chronic headaches following an injury.

Dr. Scher worked for many years as a computer scientist before deciding it was time for a change. Interested in medical research, she considered becoming a physician, but opted instead to get a PhD in Epidemiology from Johns Hopkins University School of Public Health. For her thesis, she examined Chronic Daily Headache and investigated risk factors associated with it.  Her research continues to focus on the prevalence of headache disorders in certain populations and their co-morbidities, the other conditions which may accompany them. Dr. Scher chose to focus her research on headache because she knows many people who are debilitated by headache disorders and finds the topic in dire need of research.

Dr. Scher thinks she has “a great career” as a researcher and believes she and other scientists are “privileged” to be able to spend their working days the way they do. She finds her past experience in computer science and mathematics to be quite useful, as epidemiology requires considerable data analysis, which she admits is her favorite part of her job. In her spare time, Dr. Scher works on another kind of research – genealogy and constructing her family tree.

Dr. Scher says that MRF is doing “incredible” work to address the severe under-funding of migraine and headache research. She hopes the research she is doing will help provide answers to how headache disorders can be better treated and will encourage further research by demonstrating how common and debilitating they can be.