Brain Lesions and Migraine: What's the Connection?

Migraine is one of the most common diseases worldwide, defined by strong head pain that can last from a few hours to a few days. Migraine cause headache attacks partly by overactivating pain pathways in the brain and brainstem. For a long time, experts have been unsure whether this can cause long-term brain damage.^1-3

Small or "punctate" white matter lesions (WMLs) are one of the most common types of brain imaging abnormalities associated with migraine. WMLs are small areas of the brain where neurons (the cells that carry information) or other brain cells are damaged. The tiny WMLs seen in some patients with migraine typically do not cause any symptoms. But WMLs, depending on the cause, may contribute to issues with mental and physical function, especially in older adults.^1,2

WMLs used to be one of the things that ruled out a migraine diagnosis. But in recent years, doctors have found that many people with migraine have WMLs and white matter hypersensitivities (WMHs), the precursor to WMLs.^1,3

What is a white matter lesion?

White matter lesions are small damaged areas of the brain, located in the layers below the surface. They can cause issues with how the brain communicates with itself and the body, especially over time.^1,3

WMLs may have many different causes. Some are caused by damage to the protective coating of neurons in the brain, spinal cord, and eye (demyelination). When demyelination happens, neurons have trouble communicating with each other. This can slow or stop signals around the body, leading to brain and nerve problems.^1,3

Other WMLs are caused by blockage or damage to the blood vessels around the brain (a stroke), or damage to the other brain cells that support neurons.^1,3

Some WMLs, such as those caused by demyelination and stroke, may affect long-term physical and cognitive functioning, especially as adults get older. Because of this potential link between WMLs and neurological problems, migraine could be a contributor to cognitive issues in the general population.¹

How are white matter lesions connected to migraine?

There has been some mixed research around how WMLs and migraine are connected. But doctors now generally agree that WMLs occur more often in people who have migraine disease than in those who do not.^3,4

People with migraine are estimated to have a 2 to 4 times higher risk for WMLs than those without migraine. People who have migraine with aura, those who have attacks frequently, and women with migraine are all at increased risk for WMLs as well. Advanced age and high blood pressure are also risk factors.¹

Interestingly, many WMLs have been found to occur in childhood and stay stable over time. WMLs are found in as many as 10 percent of children with migraine. The damage they cause remains over the course of their lives. However, despite the long-term presence of these small migraine-associated WMLs, they do not seem to cause long-term neurologic problems.^1-4

Why is the evidence for long-term damage unclear?

WMLs caused by damage to blood vessels are much more common than WMLs caused by migraine. Vascular issues can also be involved in causing migraine. It is possible that the mixed results of previous studies can be explained by the differences in migraine origin.²

Do migraine WMLs cause long-term brain damage?

The long-term symptoms and brain function of people with migraine and associated WMLs seem to be the same as those of people without WMLs. Though there is still much experts do not know, the priority for migraine treatment is the symptoms and pain of migraine attacks rather than the presence of lesions.