Many people who experience migraines often worry about whether these intense headaches could lead to lasting changes in their brain. Medical scans sometimes reveal small areas of altered tissue, prompting concerns about permanent damage. This article aims to clarify what these findings mean and their typical course over time, providing a clearer understanding for those affected.
Understanding Migraine Lesions
Migraine lesions are areas of altered tissue on brain imaging, most commonly seen on magnetic resonance imaging (MRI) scans. They are often called white matter hyperintensities (WMHs) because they appear as bright white spots on specific MRI sequences. WMHs are small regions in the brain’s white matter, which consists of nerve fibers connecting different brain areas. While common in migraine patients, these hyperintensities are non-specific; they can also appear in people without migraines, especially with normal aging or other conditions like stroke or dementia. Studies show WMHs are present in 43.1% to 70% of migraine patients, with higher prevalence in those with migraine with aura.
Do Migraine Lesions Remain?
Once formed, migraine-associated white matter hyperintensities are considered stable and persist. They do not disappear completely. While some studies note potential fluctuations, these lesions generally remain present on subsequent brain imaging. This persistence differs from other brain lesions that might resolve or diminish. A nine-year study of migraine patients found a slight increase in lesions, but no significant progression difference compared to those without migraine.
The stability of these lesions suggests a long-term alteration in brain tissue. While their exact formation mechanisms are not fully understood, theories include localized reductions in blood flow during migraine attacks or other vascular changes. These stable hyperintensities indicate that migraines, though episodic, can be associated with enduring, usually benign, changes in brain structure.
Implications for Health and Management
For most individuals, migraine-associated white matter hyperintensities are considered clinically benign. They typically do not cause noticeable neurological deficits or serious health problems. These lesions are often an incidental finding during a brain MRI performed for other reasons, such as evaluating persistent headaches. Experts reassure patients that these lesions are not associated with cognitive decline or thinking problems.
Despite their benign nature, managing migraines remains important. Frequent migraine attacks or a longer history of migraine disease link to a higher risk of developing these lesions. Strategies to reduce migraine frequency and severity, such as identifying and avoiding triggers, managing stress, physical activity, and prescribed medications, may help mitigate new lesion formation. A doctor might recommend further investigation only if lesions appear atypical, are unusually large, or if new neurological symptoms develop that are not typical of migraine.