STORY BYThe Debate Begins
It starts out with a light throb, then a stiff neck. It moves forward to an unbearable rhythmic beat, sending your head into a tailspin and making you nauseous. Sounds like your classic migraine headache? Or is it a sign that you have brain damage?
It may sound extreme, but that's the question researchers in the Netherlands have posed in a recent study.
The study, conducted by Dutch and American researchers at Leiden University Medical Center in the Netherlands, connected the dots between migraine and specific kinds of brain lesions in the back of the brain. However, it remains unclear if the link exists in the general migraine population. The findings were reported in the Journal of the American Medical Association.
The researchers followed 140 patients without migraine, 134 with migraine without aura (a warning sign) and 161 patients with migraine and aura.
In the study, one type of brain lesion called white matter lesions, or WMLs, were found to be more common in women with migraines than women without migraines. No connection was found in men.
The question remains: Can a throbbing headache coupled with the brain's poor blood flow spell something as serious as a stroke?
"The chance that somebody with a migraine will go on to have a stroke is very low. These researchers reported seeing silent strokes in migraine sufferers, but the numbers are very small," explains Randolph Evans, M.D., clinical associate professor of neurology at The University of Texas Medical School at Houston.
A chronic condition, migraine headaches affect 28 million each year, mostly women in their 20s to 40s. The pain can occur as rarely as once in a lifetime to as frequent as daily.
“It's more rare than common,” Evans says.Physicians are still unclear as to why migraines occur, but they partly blame abnormally sensitive neurons in the brain stem in the occipital cortex, which leads to blood vessel activation.
Evans says the new finding regarding brain strokes differs from cases he and fellow US migraine experts have found in their patients. He says he and his colleagues rarely see silent strokes in the cerebellum in people with migraines.
“It’s more rare than common,” Evans says. "We are not sure why our experience in the US is different. This is an unusual place in the brain to have a stroke."
Evans says the causes of migraines are poorly understood. He strongly agrees with the researchers that more studies are needed. The take-home message is to not to be alarmed.
"Don't expect your migraines to cause brain damage. The chances of suffering from a stroke are minimal," Evans adds, "Treatment is available, so seek it aggressively."
For people with frequent migraines, Evans suggests taking medications like antidepressants, beta-blockers and anti-seizure drugs. One effective medication called Topamax can even cause weight loss—a positive side effect. "About 68 percent of migraine sufferers who have taken Topamax lose weight," Evans points out.
If you're experiencing health problems in addition to migraines, chances are you'll need to pay even closer attention to your body and make some simple lifestyle changes to help ease the pain.
"If you smoke or have high cholesterol, you might be concerned anyway," Evans says. "By modifying your lifestyle with exercise and eating healthy, you will decrease your chances of having a stroke. That's good information for everybody, anytime."
UPDATED: 4-12-2004
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Dr. Randolph Evans is an clinical associate professor of neurology at the UT Medical School.
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