Migraine Associated with Increased Risk of Dementia in Women

by | Aug 26, 2020 | 2019, Alzheimer's Disease, Brain Health, Headaches, Women's Health

Written by Angeline A. De Leon, Staff Writer. This study suggests that a history of migraines increases the risk of dementia in women, particularly in women who are sixty years of age or older.

headache - painMigraine affects millions of individuals worldwide, the prevalence rate ranging from 5% to 15% 1. Marked by recurrent episodes of throbbing pain or pulsating sensations on the side of the head 2, migraines are considered a neurological condition involving an excitatory-inhibitory imbalance in the brain 3. Research has shown that individuals suffering from migraines also exhibit distinct functional and structural changes at the cortical level, which may be related to increased risk of cognitive dysfunction 4,5. A large population-based study demonstrated, for example, that subjects experiencing migraines were at higher risk for any type of dementia 6, while a recent meta-analytic study reported a general relationship between migraine attacks (duration, severity, and frequency) and neuropsychological impairment 7. Although the exact neurophysiological mechanisms associated with migraines are still under study, brain imaging studies suggest that decreased cerebral blood flow and inflammatory pathways may be involved 8,9. Long-lasting migraines may even cause permanent brain damage due to sustained elevations in oxidative stress, leading to neurodegeneration 10,11. Overall, neuroimaging research suggests that neural changes associated with cognitive impairment during migraine attacks may also overlap with those observed in cases of dementia 12. To validate this, a recent case-control study 13 published in Medicine (2019) sought to determine the relationship between prior history of migraine and diagnosis of dementia.

A total of 11,438 dementia patients (diagnosed with Alzheimer’s Disease or dementia in Alzheimer’s Disease and receiving 2 or more medical treatments for their condition) and 45,752 control participants (all aged 60 years and older) were enrolled in a national, nested case-control study and matched 1:4 based on age, sex, income, region of residence, and past medical history (hypertension, diabetes, and dyslipidemia). Migraine was diagnosed using the ICD-10 (International Classification of Diseases, 10th Revision) and only included patients who visited an outpatient clinic twice or more for the same migraine episode. Odds Ratios (ORs) were calculated for migraine with dementia.

Compared to the control group, the rate of a reported history of migraine was found to be significantly higher in the dementia group (7.7% [881/11,438] vs. 6.3% [2,888/45,752]) (p < 0.001). Adjusted OR for migraine with dementia was also 1.13 times higher in the dementia group vs. control (95% Confidence Interval: 1.05 to 1.23) (p = 0.02). Finally, a subgroup analysis based on age and sex revealed a significantly higher adjusted OR for migraine with dementia in women vs. men (OR for women younger than 70 = 1.35 [95% CI: 1.08 to 1.68], OR for women 70 years and older = 1.12 [95% CI= 1.02 to 1.23]) (p < 0.05 for both).

Based on findings, researchers conclude that having a history of migraine seems to increase the risk of developing dementia, with the strongest association between migraine and dementia observed for women younger than 70 years old. This finding appears to be congruent with evidence indicating a higher risk of dementia in women vs. men 14 and a stronger association between dementia and migraine in younger rather than older individuals 6. Prospective studies are needed to further explore these sex- and age-based differences. Several study limitations should be considered in the current investigation, including the inability to draw causal relations due to the nature of the study design; failure to include different subtypes of dementia; and lack of control for confounding variables such as depression and anxiety.

Source: Lee S-Y, Lim J-S, Oh DJ, et al. Increased risk of neurodegenerative dementia in women with migraines. Medicine. 2019; 98: 7. DOI: 10.1097/MD.0000000000014467.

Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NCND)

Click here to read the full text study.

Posted August 26, 2020.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

References:

  1. Lipton RB, Scher AI, Kolodner K, Liberman J, Steiner TJ, Stewart WF. Migraine in the United States: epidemiology and patterns of health care use. Neurology. 2002;58(6):885-894.
  2. Friedman BW. Managing Migraine. Ann Emerg Med. 2017;69(2):202-207.
  3. Vecchia D, Pietrobon D. Migraine: a disorder of brain excitatory-inhibitory balance? Trends Neurosci. 2012;35(8):507-520.
  4. Bashir A, Lipton RB, Ashina S, Ashina M. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013;81(14):1260-1268.
  5. Amin FM, Hougaard A, Magon S, et al. Change in brain network connectivity during PACAP38-induced migraine attacks: A resting-state functional MRI study. Neurology. 2016;86(2):180-187.
  6. Chuang CS, Lin CL, Lin MC, Sung FC, Kao CH. Migraine and risk of dementia: a nationwide retrospective cohort study. Neuroepidemiology. 2013;41(3-4):139-145.
  7. Gil-Gouveia R, Oliveira AG, Martins IP. Assessment of cognitive dysfunction during migraine attacks: a systematic review. Journal of neurology. 2015;262(3):654-665.
  8. Zhang Q, Datta R, Detre JA, Cucchiara B. White matter lesion burden in migraine with aura may be associated with reduced cerebral blood flow. Cephalalgia. 2017;37(6):517-524.
  9. Kruit MC, van Buchem MA, Launer LJ, Terwindt GM, Ferrari MD. Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia. 2010;30(2):129-136.
  10. Peers C, Dallas ML, Boycott HE, Scragg JL, Pearson HA, Boyle JP. Hypoxia and neurodegeneration. Ann N Y Acad Sci. 2009;1177:169-177.
  11. Moskowitz MA, Macfarlane R. Neurovascular and molecular mechanisms in migraine headaches. Cerebrovascular and brain metabolism reviews. 1993;5(3):159-177.
  12. Sprenger T, Borsook D. Migraine changes the brain: neuroimaging makes its mark. Curr Opin Neurol. 2012;25(3):252-262.
  13. Lee SY, Lim JS, Oh DJ, Kong IG, Choi HG. Increased risk of neurodegenerative dementia in women with migraines: A nested case-control study using a national sample cohort. Medicine (Baltimore). 2019;98(7):e14467.
  14. Azad NA, Al Bugami M, Loy-English I. Gender differences in dementia risk factors. Gender medicine. 2007;4(2):120-129.