Understanding Migraine-Related Brain Lesions on Your MRI

Research indicates that migraines are associated with lesions in the brain, as seen on a magnetic resonance imaging (MRI) scan. A lesion occurs because of some sort of damage to the part of the brain where it's located. Right now, experts simply don't know whether or not these migraine-related brain lesions may have a long-term effect on your health, so doctors aren't worrying too much about them until more is known about their relevance.

Scientific studies looking into the potential effect of these lesions on your migraine and overall health are important not only for the future of migraine therapy, but also to provide further insight into the brain mechanism behind migraines. 

migraine-related brain lesions
Illustration by Cindy Chung, Verywell

Migraines and the Brain

Although it's rare, we know that migraine can cause a stroke, called a migrainous infarction or migraine-induced stroke. Similarly, migraine with aura is a risk factor for stroke in certain people, especially women and those who smoke, have high blood pressure, or take birth control pills.

In addition, multiple studies have found that people with migraines have an increased risk of brain lesions.

The two main types of lesions found in migraineurs include:

  • White matter hyperintensities (WMH): These lesions appear bright white on certain sequences of MRI scans. These abnormalities can also be seen in elderly people and patients with stroke and dementia. In migraineurs, they're typically found in the frontal lobe, limbic system, and parietal lobe of the brain.
  • Silent brain infarcts: An infarct is a small area of dead tissue that's a result of restricted blood flow to the area. When infarcts are "silent," this means that they're not linked to any obvious stroke-like symptoms. Silent infarcts in migraineurs have mostly been found in the cerebellum, the brainstem, the supratentorial region, and deep in the gray matter of the brain.

Experts have been trying to piece together the precise cause of these brain lesions, deciphering whether they're caused by the effects of migraine itself or by some other factor specific to migraineurs.

What the Research Shows

While it's clear that migraine is a risk factor for developing subclinical brain lesions, the causes, nature, and long-term outcomes are still uncertain and the research is somewhat inconsistent.

As of now, research indicates that the presence of brain lesions seems to be more common in women, especially those who have frequent migraine attacks and who have a long history of migraines. Lesions are also associated more strongly with people who have migraine with aura.

As far as other causes for brain lesions, a 2015 study examined the relationship of cardiovascular risk factors (factors that increase your chance of having a stroke or heart attack), like smoking, high blood pressure, body mass index (BMI), and high cholesterol, to the presence of white matter hyperintensities in migraineurs.

The results indicated that these cardiovascular risk factors weren't associated with WMH in people with migraine, and other studies have shown similar results. The authors suggest that the effects of migraine itself may be the direct cause for the brain lesions.

It's possible that there are other factors involved too. For instance, some scientists recommend studying the relationship between a patent foramen ovale (PFO) and brain lesions in migraines. A PFO, which is a hole in your heart, is more common in migraineurs with aura and is found in about one-fifth of the population. PFO increases your risk of stroke, as tiny blood clots can travel from the heart through the hole to the brain.

The Significance of Brain Lesions

We don't really know what the significance of these brain lesions is yet. A number of studies have examined older people who do not have migraines but have white matter hyperintensities, and these lesions are associated with an increased risk of stroke, dementia, and thinking problems. Since migraine is associated with stroke, it's possible that lesions in migraineurs could be an indication of a higher risk of stroke.

A 2012 study found that while female migraineurs had a higher incidence of white matter hyperintensities over a period of nine years compared to a control group, their cognitive functioning stayed the same. This indicates that these brain lesions may, in fact, mean nothing health-wise, which is reassuring news.

That said, if migraines and their associated brain lesions are found to have long-term neurological effects, this may alter the way neurologists treat episodic migraines. For example, doctors may consider migraine preventive medication for episodic migraines in certain people who are at high risk for developing brain lesions or who already have them.

A Word From Verywell

It's uncertain whether brain lesions have any health implications. If you have them, the best thing you can do is work to stay on top of your migraine health by regularly following up with your doctor, taking your medication as prescribed, and monitoring your triggers. Long-term studies that examine the presence and progression of these brain lesions in light of neurological function over time are on the horizon and will help shed new light on the situation.

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