Finding an unexpected result on a brain scan, such as small brain changes often called lesions, can cause significant anxiety for individuals managing chronic migraine. These observable markers on imaging scans highlight that migraine is a complex neurological event that can leave behind physical evidence. Understanding what these changes are and their clinical significance is the first step toward managing this aspect of the condition.
What Are Migraine-Related Brain Lesions?
The “lesions” associated with migraine are most commonly identified as White Matter Hyperintensities (WMHs). They appear on a Magnetic Resonance Imaging (MRI) scan as small, bright spots. These hyperintensities are typically located in the deep white matter of the brain, which connects different brain regions and facilitates communication.
The exact biological cause of these WMHs is not fully understood, but they are thought to be related to the neurological events of a migraine attack. One leading theory suggests they result from brief, localized issues with blood flow, such as focal hypoperfusion, during the migraine event. These transient reductions in blood flow may cause minor damage or scarring to the white matter tissue. The presence of these lesions is seen more frequently in people who experience migraines, particularly those with migraine with aura, higher attack frequency, and a longer disease history.
Do These Lesions Go Away?
White Matter Hyperintensities seen on MRI scans are generally persistent once formed. Unlike acute injuries, these spots of altered tissue do not typically disappear or resolve completely over time. However, this persistence should not cause alarm, as the vast majority of migraine-related WMHs are considered benign and non-symptomatic.
These lesions rarely correlate with measurable neurological issues, such as cognitive decline, memory problems, or functional impairment. Studies tracking individuals with these findings over many years have shown that their cognitive function remains comparable to people without the hyperintensities. This lack of clinical significance distinguishes these migraine-associated changes from lesions seen in severe conditions like multiple sclerosis or stroke.
While the lesions tend to remain, their overall impact on a patient’s health is low. The primary focus remains the effective management of the migraine disease itself. The discovery of WMHs often prompts a neurologist to emphasize the importance of a consistent treatment plan.
Reducing the Risk of New Lesion Formation
Since existing lesions are persistent, the most effective approach is preventing the formation of new ones. Effective and consistent prophylactic treatment for migraine is the best defense against developing new White Matter Hyperintensities. Controlling the frequency and severity of attacks reduces the overall burden of the disease on the brain.
Patients with a higher frequency of migraine attacks are at an increased risk of developing additional lesions over time. Working closely with a neurologist to find an optimal preventive medication regimen is paramount for those concerned about progressive brain changes. The risk of developing new lesions is significantly higher in patients with five or more attacks per month compared to those with fewer.
Beyond medication, managing lifestyle factors that influence vascular health plays a preventative role. Controlling traditional vascular risk factors, such as high blood pressure and elevated cholesterol, is important because these can contribute to the formation of white matter changes. Adopting healthy habits, including regular physical activity and stress management, can further mitigate the risk of new lesions.