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Migraine with Aura in Midlife Is Linked to Dementia

The risk of developing dementia later in life appears to be greater in people who have migraine attacks accompanied by aura, researchers reported at the virtual annual scientific meeting of the American Headache Society.

The findings, which were based on a Danish population-based cohort study, support the hypothesis that migraine is a midlife risk factor for dementia in later life, the study authors wrote. While migraine and a risk of dementia had previously been reported, those studies did not differentiate between patients with or without aura, they said.

For the analysis, the researchers retrieved data from a national Dutch register from 1988–2017, scrutinizing records for people born between 1935 and 1956 for a total of 1,657,890 people before they turned 59 years old; approximately 18,135 had migraine. They followed the individuals for dementia from age 60, matching them on the basis of sex and birth date with individuals without migraine. In total, 62,578 were eligible for the analyses.

"Compared with individuals without migraine, we found a 50 percent higher rate of dementia among individuals with migraine (HR = 1.50; 95% CI: 1.28-1.76)," reported Jakob Moller Hansen, MD, PhD, MSc, director of the Danish Headache Knowledge Center and a consultant at the Danish Headache Center at Rigshospitalet in Copenhagen, Denmark.

But in individuals without aura, the hazard ratio was 1.19, and that failed to achieve statistical significance, Dr. Hansen told Neurology Today At the Meetings. On the other hand, in individuals whose migraine was accompanied by aura the hazard ratio was 2.11 (95% CI: 1.48-3.00), a significant difference, he said.

Dr. Hansen said that the risk of dementia among the patients diagnosed with migraine did not differ by sex. He noted that migraine with aura is a risk factor for ischemic stroke, whereas no increased risk is found for migraine without aura. 

"Our data suggest that individuals with migraine with aura had the highest hazard ratio of dementia, which aligns with previous evidence that support strong vascular mechanisms in migraine with aura," he said. "This also adds to the knowledge on severe long-term consequences of migraine with aura."

Dr. Hansen said the researchers are working on assessing the impact of migraine with or without aura by analyzing potential modifying factors such as attack frequency and types of treatment. "In general, modifiable risk factors for cardiovascular diseases should be tended to," he said. "We are currently looking at just that—the impact of migraine treatment on dementia in migraine patients."

Commenting  on the study, Jessica Ailani, MD, FAAN, associate professor of neurology at MedStar's Georgetown University and MedStar Georgetown Medical Center in Washington, DC, said, "When we look at patients with migraine with aura and those without aura, we wonder if the mechanism of both disorders is similar or if there are some major changes. We know that cortical spreading depression is involved with migraine with aura. We know that in migraine with aura there are changes in white matter in the brain. We question if there is an effect with aura on the vascular system because of changes in endothelial cells. We want to know if there may be a greater 'stickiness' of cells with aura."

"Patients are always asking us about a correlation of dementia with migraine," Dr. Ailani told Neurology Today At the Meetings. "We do know that the greatest risk for dementia is not Alzheimer's disease but is vascular disease caused by high blood pressure and other factors that can cause long-term changes in the brain that can cause memory issues and trouble functioning.

"This study by Dr. Hansen makes one think that there could be a connection between migraine with aura and vascular changes, which may lead to dementia," she said.

"If we could reduce the frequency of migraine attacks, could we reduce the risk of having more of these events such as mini-blood clots and vascular stickiness?" Dr. Ailani asked. "We need to treat migraine early and aggressively. We also need to keep patients under good blood pressure control, keep diabetes in check, and reduce hyperlipidemia as well," Dr. Ailani said.

Disclosures: Dr. Hansen has received speakers' fees from Teva, Novartis, and Eli Lilly. Dr. Ailani receives an honorarium for consulting and serving on the advisory board for Allergan, Amgen, Alder/Lundbeck, Biohaven, Eli Lilly, Teva, Impel, Satsuma, Revance, and Zosano. She serves on the speaker's bureau for Allergan, Amgen, Biohaven, Eli Lilly, Lundbeck, and Teva, and has received research funding from clinical trials from  the American Migraine Foundation, Allergan, Biohaven, Eli Lilly, Satsuma, and Zosano.

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AHS Abstract: Islamoska S, Hansen JM, Hansen AM, et al. Migraine as a risk factor for dementia: A national register-based follow-up study.