Migraines Can Come With ‘Fellow Travelers’

If you suffer from migraine headaches, you suffer enough. These aren’t just headaches: They are life-disrupting events that can send you to bed for hours or days at a time, unable to tolerate light, sound, odors or human contact.

So the last thing you want to hear is that your headaches are linked with other health problems and may even raise your risk for strokes, heart attacks and other serious illnesses.

But researchers are finding increasing evidence for just such links. “Both doctors and patients need to know that migraine has a large number of fellow travelers,” says Richard Lipton, a neurologist at Albert Einstein College in New York and a spokesman for the American Academy of Neurology.

Migraine, once dismissed as “a disorder of neurotic women,” is a serious health problem, says Stephen Silberstein, a neurologist at Thomas Jefferson University in Philadelphia.

Recently, researchers have reported links with:

• Heart attack. They were twice as common (4% vs. 2%) in people with migraines in one large study co-written by Lipton. The risk was especially high in women who had migraines with aura — sensations that occur before the headache and can include seeing flashing or zigzagged lights.

• Brain damage. Brain lesions become more common with age. But women who’d had migraines with aura in middle age were more likely than other women to have the lesions on a part of the brain called the cerebellum when given a brain scan later in life. More study is needed to learn whether such lesions can be caused by migraine and whether they are linked with cognitive or functional impairment, says Lenore Launer, a researcher at the National Institute on Aging.

• Multiple sclerosis. Women with migraine were 47% more likely to develop MS than those without the headaches in one study.

Other research has linked migraine with stroke, depression and epilepsy.

When health problems are linked, it does not necessarily mean that one causes the other. Sometimes they share underlying causes. Sometimes the link is a statistical illusion.

In the case of migraine and depression, a cause-and-effect relationship seems likely and seems to go both ways. People with any chronic pain often endure “a cycle of disability, isolation and suffering” that can trigger depression, says Andrew Ahn, a neurologist at the University of Florida-Gainesville. And depressed people are more vulnerable to pain.

Also, some genes may raise risks of both migraine and depression. Underlying biological links also seem likely for migraines and epilepsy. That fits with a growing understanding that migraine is “fundamentally a disorder of hyper-excitability of the brain,” Silberstein says.

But the relationship between migraine and some other disorders is murkier. That’s certainly true for MS. Study on that link is just starting, says Ilya Kister, a researcher at New York University. In any case, he says, “99% of women with migraines will not develop MS.”

Research on migraine and cardiovascular conditions is more advanced but still incomplete. These health problems appear to share some underlying causes. But doctors also know that changes in brain blood flow during a migraine with aura can, in rare cases, lead directly to a stroke, Lipton says. That’s of particular concern, he says, for younger adults who otherwise are at very low stroke risk.

For now, there is no proof that treating migraines prevents heart attack, stroke or other conditions.

Still, migraine patients have ample reason to discuss other health concerns with their doctors and to exercise, eat well and control blood pressure, cholesterol and weight.

Lipton says: “Good health care requires recognizing not only the migraine but the whole party that may be traveling together.”

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