Headache, migraine, and structural brain lesions and function: population based Epidemiology of Vascular Ageing-MRI study.
OBJECTIVE
To evaluate the association of overall and specific headaches with volume of white matter hyperintensities, brain infarcts, and cognition.


METHODS
Population based, cross sectional study.


METHODS
Epidemiology of Vascular Ageing study, Nantes, France.


METHODS
780 participants (mean age 69, 58.5% women) with detailed headache assessment.


METHODS
Brain scans were evaluated for volume of white matter hyperintensities (by fully automated imaging processing) and for classification of infarcts (by visual reading with a standardised assessment grid). Cognitive function was assessed by a battery of tests including the mini-mental state examination.


RESULTS
163 (20.9%) participants reported a history of severe headache and 116 had migraine, of whom 17 (14.7%) reported aura symptoms. An association was found between any history of severe headache and increasing volume of white matter hyperintensities. The adjusted odds ratio of being in the highest third for total volume of white matter hyperintensities was 2.0 (95% confidence interval 1.3 to 3.1, P for trend 0.002) for participants with any history of severe headache when compared with participants without severe headache being in the lowest third. The association pattern was similar for all headache types. Migraine with aura was the only headache type strongly associated with volume of deep white matter hyperintensities (highest third odds ratio 12.4, 1.6 to 99.4, P for trend 0.005) and with brain infarcts (3.4, 1.2 to 9.3). The location of infarcts was predominantly outside the cerebellum and brain stem. Evidence was lacking for cognitive impairment for any headache type with or without brain lesions.


CONCLUSIONS
In this population based study, any history of severe headache was associated with an increased volume of white matter hyperintensities. Migraine with aura was the only headache type associated with brain infarcts. Evidence that headache of any type by itself or in combination with brain lesions was associated with cognitive impairment was lacking.
INSERM Unit 708--Neuroepidemiology, Paris, France. tobias.kurth@upmc.fr
Tobias
T
Kurth
Shajahal
S
Mohamed
Pauline
P
Maillard
Yi-Cheng
YC
Zhu
Hugues
H
Chabriat
Bernard
B
Mazoyer
Marie-Germaine
MG
Bousser
Carole
C
Dufouil
Christophe
C
Tzourio
D000368:Aged; D001927:Brain Diseases / Q000473:pathology*; D002544:Cerebral Infarction / Q000473:pathology* / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D020773:Headache Disorders / Q000473:pathology* / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male
J Psychiatr Res. 1975 Nov;12(3):189-98
1202204
Neurology. 2008 Jul 8;71(2):108-13
18606964
Lancet Neurol. 2009 Jul;8(7):643-53
19539236
Headache. 1996 Nov-Dec;36(10):616-21
8990603
J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):808-11
15145989
Lancet Neurol. 2008 Apr;7(4):354-61
18339350
JAMA. 2006 Jul 19;296(3):283-91
16849661
Ann Neurol. 2010 Feb;67(2):221-9
20225282
Am J Epidemiol. 1997 Sep 1;146(5):405-12
9290500
Neurology. 1999 Oct 22;53(7):1468-73
10534253
Brain. 2005 Sep;128(Pt 9):2068-77
16006538
J Neurol Neurosurg Psychiatry. 2003 Feb;74(2):238-41
12531958
BMJ. 2009 Oct 27;339:b3914
19861375
Ann Neurol. 2003 Feb;53(2):214-21
12557288
Neurology. 2007 May 8;68(19):1563-70
17460157
Headache. 2006 Feb;46(2):312-6
16492241
J Headache Pain. 2010 Aug;11(4):289-99
20473702
Am J Med. 2005 Mar;118 Suppl 1:3S-10S
15841882
BMJ. 2010 Aug 24;341:c3659
20736268
Neurology. 2007 Jan 9;68(2):134-40
17210894
Arch Neurol. 2004 Sep;61(9):1366-8
15364681
Diabetologia. 2007 Jul;50(7):1509-16
17492428
Neurology. 2009 Jun 16;72(24):2111-4
19528518
BMJ. 1995 Apr 1;310(6983):830-3
7711619
Neuroradiology. 2008 Jan;50(1):31-42
17938898
Headache. 1992 Jun;32(6):287-91
1399549
Cephalalgia. 2007 Mar;27(3):193-210
17381554
Stroke. 2009 Jul;40(7):2327-31
19443799
BMJ. 2010 Aug 24;341:c3966
20736269
Neurology. 2010 Feb 23;74(8):628-35
20147658
Ann Neurol. 2009 Jun;65(6):706-15
19557865
Neurology. 1999 Aug 11;53(3):537-42
10449117
JAMA. 2009 Jun 24;301(24):2563-70
19549973
Eur J Neurol. 2010 Mar;17(3):419-25
19968707
Stroke. 2006 Apr;37(4):1109-12
16497982
BMJ. 2010 Jul 26;341:c3666
20660506
Neurology. 2001 May 22;56(10):1273-7
11376172
Headache. 2010 Feb;50(2):176-84
19925622
N Engl J Med. 2007 Nov 1;357(18):1821-8
17978290
J Neurol Sci. 2009 Aug 15;283(1-2):134-6
19268310
BMJ. 2009 Jul 06;339:b2477
19581317
Neurology. 2005 Feb 22;64(4):614-20
15728281
JAMA. 2004 Jan 28;291(4):427-34
14747499
Eur J Neurol. 2006 Dec;13(12):1364-9
17116221
Cephalalgia. 2008 May;28(5):531-40
18355348
Cephalalgia. 1991 May;11(2):69-74
1860133
Am J Epidemiol. 1986 Jul;124(1):17-27
3521261
Neurology. 2008 Aug 12;71(7):505-13
18672474
Headache. 1995 May;35(5):264-8
7775189
Neurology. 2000 Jan 25;54(2):507-9
10668727
Neurology. 2001 Apr 10;56(7):921-6
11294930