Midlife migraine/aura linked with late-life brain infarcts.

WASHINGTON -- Migraines in midlife with accompanying visual aura predict later-life brain infarcts, according to a poster presentation at the annual meeting of the American Neurological Association.

Furthermore, the relationship between migraine with aura and late-life cortical and cerebella infarcts "was not explained by measured cardiovascular risk factors," wrote the authors.

In a longitudinal, population-based MRI study, A.I. Scher, Ph.D., of the National Institute on Aging, in Bethesda, Md., and associates looked at 1,843 subjects (812 men) from the Reykjavik (Iceland) Study, which began in 1967. All patients were born between 1907 and 1935, and had an average follow-up of 25 years. "Midlife" assessments took place at an average age of 49 (range 34-59 years), and "late-life" assessments occurred at an average age of 75 (range 66-90 years).

For patients who reported headache once or more per month, data were gathered about nausea or vomiting, unilateral location, phototopia, visual disturbance during/just before headache, and unilateral numbness before headache. They were assessed for cardiovascular risk factors, including blood pressure, total cholesterol, triglycerides, fasting glucose, hypertension, diabetes, and smoking status.

Participants underwent a Flair MRI in 2002, and subcortical, cortical, and cerebella infarcts were examined.

Overall, 80% of men and 60% of women experienced none of the associated headache symptoms, listed above. Some 14% of men and 22% of women experienced one to two symptoms; slightly less than 2% of men and nearly 7% of women experienced three or more symptoms. About 4% of men and 8% of women experienced headache with visual aura. Other symptoms were reported by a small minority of men and women.

The odds ratio (OR) of late-life brain infarcts in those with headache plus visual aura versus those without headache symptoms (adjusted for age, gender, sampling stage, and duration of follow-up) was 2.35 in the cortical region (P less than .005). Those with headache and visual aura had an OR of 1.82 of having an infarct in the cerebellar region, compared with non-headache subjects (P less than .05). The odds for migraineurs with aura having an infarct in the subcortical region were neither increased nor significant.

Those who reported other symptoms did not have significantly increased odds of brain infarcts in the observed regions.

"The relationship between midlife headache with visual aura and late-life infarcts was not explained by measured cardiovascular risk factors," the authors wrote.

BY DENISE NAPOLI

Assistant Editor