Written by Joyce Smith, BS. Study finds that migraine history is a significant risk factor for Alzheimer disease (AD) and all‐cause dementia, but not vascular dementia in a population of older independently-living adults.
Dementia is a neurological age-related disease that inflicts almost fifty percent of all ages worldwide 1. It is increasing with our aging population and has a greater affinity for women than men (20% v.s. 8%). Migraines are the most debilitating of headaches 2, and both dementia and migraines severely impact not only the recipient and family members, but society as well. Thus, identifying predictors of dementia is critical, given its current increase in prevalence and expected future growth as the population ages. Evidence of an association between migraines and dementia is poorly defined and may vary by dementia subtype, headache versus migraine, gender, and comorbidities 3-5; thus, exploring a potential relationship between migraines and dementia would hopefully create new prevention and treatment options and provide better clarity regarding the etiologies of these disorders.
In a prospective cohort study of community dwelling adults, Morton and colleagues investigated a potential relationship between migraines and dementia, Alzheimer’s (AD), and vascular dementia (VaD) 6 and included any contributing conditions such as hypertension, myocardial infarction, other heart conditions, stroke, and diabetes. The researchers used a subset of data (2,890 people) from the Manitoba Study of Health and Aging, part of the longest continuous study of aging in Canada. Analyses was based on 679 community‐dwelling participants of whom 61.9% were women with a mean age of 75.9 years. Only community‐dwelling participants with unimpaired baseline cognition levels (1,355) based on the Modified Mini State Exam were selected for interviews and mail in questionnaires. The final selection process provided researchers with an analytic sample that was based on 679 individuals who screened cognitively intact at baseline, provided adequate data on migraine history and potential confounders, and completed the cognitive assessment at follow‐up 5 years later at which time they were re-assessed for cognitive outcomes (all‐cause dementia, AD, and VaD).
Using multiple logistic regression models, researchers found that patients with a history of migraines were 3 and 4 times more likely to be diagnosed later with both all‐cause dementia (odds ratio [OR], 2.97; 95% CI, 1.25‐6.61) and AD (OR, 4.22; 95% CI, 1.59‐10.42), even after adjustment for confounding and intervening variables. However, migraines were not significantly associated with vascular dementia either before (OR, 1.83; 95% CI, 0.39‐8.52) or after (OR, 1.52; 95% CI, 0.20‐7.23) such adjustment, despite vascular involvement in migraines. At follow‐up 5 years later, 7.5% (n = 51) of participants had developed dementia, 5.1% (n = 34) had developed AD, and 1.9% (n = 12) had developed vascular dementia. While this study reflected a strong association of migraines with dementia in women, it was unable to assess potential gender differences because no male participants had dementia or a history of migraines.
Also, compared with cognitively intact participants, those with dementia, AD, or VaD were significantly older, and those with dementia or AD had significantly less education. Stroke was significantly more prevalent in participants with dementia or VaD than in those who were cognitively intact. The association of other heart conditions with VaD was marginally significant (.05≤p<.10).
Study limitations include the use of self-reported health questionnaires, the exclusion of medical records where diagnosis was based on standard migraine criteria, no distinction between migraines with or without aura, and no generalization of results (there was no accounting for deaths during the 5-year follow-up).
There is presently no cure for Alzheimer’s; thus, by having identified a link to migraines, this study may lead to new strategies that prevent Alzheimer’s disease. Researchers recommend earlier screening for cognitive decline in those who suffer from migraines and more aggressive treatment to delay dementia and promote healthy aging.
Source: Morton, Rebecca E., Philip D. St. John, and Suzanne L. Tyas. “Migraine and the risk of all‐cause dementia, Alzheimer’s disease, and vascular dementia: A prospective cohort study in community‐dwelling older adults.” International journal of geriatric psychiatry 34, no. 11 (2019): 1667-1676.
© 2019 John Wiley & Sons, Ltd.
Posted July 28, 2020.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
References:
- Stovner L, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3):193-210.
- Diener HC, Beck CA. Migraine and risk of cardiovascular disease in women: learning about relative and absolute risk. Neurology. 2009;73(8):576-577.
- Wang J, Xu W, Sun S, Yu S, Fan L. Headache disorder and the risk of dementia: a systematic review and meta-analysis of cohort studies. J Headache Pain. 2018;19(1):95.
- 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.
- Stræte Røttereng AK, Bosnes O, Stordal E, et al. Headache as a predictor for dementia: The HUNT Study. J Headache Pain. 2015;16:89.
- Morton RE, St John PD, Tyas SL. Migraine and the risk of all-cause dementia, Alzheimer’s disease, and vascular dementia: A prospective cohort study in community-dwelling older adults. Int J Geriatr Psychiatry. 2019;34(11):1667-1676.
