title: Migraine and structural changes in the brain: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the association between migraine without aura (MO) and migraine with aura (MA) and 3 types of structural brain abnormalities detected by MRI: white matter abnormalities (WMAs), infarct-like lesions (ILLs), and volumetric changes in gray and white matter (GM, WM) regions.
  
  
  METHODS
  PubMed as well as the reference lists of identified studies and reviews were used to identify potentially eligible studies through January 2013. Candidate studies were reviewed and eligible studies were abstracted. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for WMAs and ILLs.
  
  
  RESULTS
  Six population-based and 13 clinic-based studies were identified. The studies suggested that structural brain changes, including WMAs, silent ILLs, and volumetric changes in GM and WM regions, were more common in migraineurs than in control groups. The results were strongest for MA. The meta-analysis of WMAs showed an association for MA (OR 1.68; 95% CI 1.07-2.65; p = 0.03) but not for MO (OR 1.34; 95% CI 0.96-1.87; p = 0.08). The association of ILLs was greater for MA (OR 1.44; 95% CI 1.02-2.03; p = 0.04) than for MO, but no association was found for MA (p = 0.52) and MO (p = 0.08) compared to controls.
  
  
  CONCLUSIONS
  These data suggest that migraine may be a risk factor for structural changes in the brain. Additional longitudinal studies are needed to determine the differential influence of migraine without and with aura, to better characterize the effects of attack frequency, and to assess longitudinal changes in brain structure and function.
authors.affiliation: From the Danish Headache Center and Department of Neurology (A.B., M.A.), Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark; Montefiore Headache Center (R.B.L.), Department of Neurology, Albert Einstein College of Medicine, Bronx; and Headache Program (S.A.), Department of Pain Medicine and Palliative Care, Department of Neurology, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, NY.
authors.forename: Asma
authors.initials: A
authors.lastname: Bashir
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.forename: Sait
authors.initials: S
authors.lastname: Ashina
authors.forename: Messoud
authors.initials: M
authors.lastname: Ashina
mesh_terms: D001921:Brain / Q000473:pathology*; D020520:Brain Infarction / Q000473:pathology*; D006801:Humans; D056784:Leukoencephalopathies / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D020325:Migraine with Aura / Q000473:pathology*; D020326:Migraine without Aura / Q000473:pathology*