Migraine is known to subside in most people, often when they reach their 40s or 50s.   A recent report from Sweden suggests that even patients with more severe migraines who end up going to a headache clinic have favorable long-term prognosis.  One third of both men and women reported complete cessation of their migraines.  Of the other two thirds the majority reported reduction in frequency and duration of attacks 12 years after their initial visit to the headache clinic.  The bad news is that many of the patients who continued to have headaches still had some impairment of quality of life.

Pain of migraine can be localized to the face and around the mouth according a two recent reports. Dr. Gaul and colleagues reported in journal Cephalalgia on two patients who had dental pain as well as typical migraine symptoms, including throbbing, sensitivity to light and noise and in one of the patients visual aura (flickering colorful lights) preceding the attack. This report confirms the fact that pain of migraine can occur anywhere in the head, including teeth, eyes, ears, forehead, top or back of the head.

Dr. Tietjen reports in the current issue of Neurology on a survey performed at six headache clinics. A total of 949 women with migraine completed the survey: 40% had chronic headache (that is headaches occuring on more than 15 days each month) and 72% had “very severe” headache-related disability. Major depression was recorded in 18%. Physical or sexual abuse was reported in 38%, and 12% reported both physical and sexual abuse in the past. Migraineurs with current major depression reported physical and sexual abuse in higher frequencies compared to those without depression. Women with major depression were more likely to report sexual abuse occurring before age 12 years and the relationship was stronger when abuse occurred both before and after age 12 years. Women with major depression were also twice as likely to report multiple types of maltreatment compared to those without depression. Similar findings have been reported in patients with chronic pain other than headaches. Brains of migraine sufferers have been found to be more excitable than brains of people without migraines. It is likely that trauma of abuse makes the nervous system even more excitable and more prone to developing chronic pain and headaches.

Researchers at several companies are using brain images obtained by an MRI machine to train people with chronic pain how to control their pain. These MRI images are not of the type that are routinely taken to look at the brain structure. Instead, these are images obtained by “functional MRI” which show how different parts of the brain react to pain. By seeing these images of pain displayed as a flame patients are able to reduce the size of the flame and also reduce their pain. It is similar to what is done during old-fashioned biofeedback sessions where patients monitor their temperature or muscle tension and by learning to control these functions of the body are also able to reduce their pain and prevent migraine headaches. It is possible that functional MRI feedback training will prove to be more effective, but it is also likely to be much more expensive.

In a study presented at the recent meeting of the American Psychiatric Association Dr. Stephen Woolley found that adults suffering from severe headaches have a 30% to 50% increased chance of having suicidal thoughts or behaviors, independent of the presence of anxiety or depression. The recommendation for the doctors is to routinely screen patients suffering from severe headaches for suicidality even if they do not suffer from anxiety or depression. Family members and friends should also be aware of this fact and discuss it openly with headache sufferers.

A study published in a recent issue of journal Neurology found that adolescents who suffer from chronic daily headache, particularly if they also had migraine with aura had a six times higher risk of suicide than their headache-free peers. This was a community-based study conducted by Dr. Shuu-Jiun Wang in Taiwan. Almost half of adolescents with headaches had at least one psychiatric disorder. The most common disorders were major depression which was found in 21% and panic disorder in 19%.

Brain damage from migraines? Maybe, if you are a mouse. A recent study published in the journal Nature Neuroscience discovered that a process that simulates migraine in mice leads to brain damage similar to that seen with repeated ministrokes. It is true that patients with migraines with aura (visual disturbance that precedes headaches, which occurs in about 15% of migraine sufferers) have an increased risk of strokes, but this risk is still very low. The vast majority of migraine sufferers stop having migraines in their 40s and 50s and we have no evidence that having migraines for many years causes any permanent brain damage. What happens to mice can never be directly extrapolated to humans. (See my comments on Fox News under NYHC in the News)

Cluster headaches are much more common in men. Cluster headaches are much more common in men. However, they do occur in women and in the latest issue of journal Headache Dr. T. Rozen presents the first report of a woman who was having cluster attacks only with her menstrual cycle.

Women with migraine have a higher chance of also having endometriosis. A study by Dr. Gretchen Tietjen and her colleagues published in the latest issue of journal Headache looked at 171 women with migraine and 104 controls. Endometriosis was reported more commonly in migraineurs than in controls (22% vs 9.6%). Frequency of chronic headache was higher in migraineurs with endometriosis ompared to without it and headache-related disability scores were also higher in the endometriosis group. Depression, anxiety, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, and interstitial cystitis were more common in migraine with endometriosis group than in controls. Anxiety, interstitial cystitis and chronic fatigue syndrome were more common in migraine with endometriosis group, than in the patients with migraine without endometriosis.

However, presence of any brain lesion is worrisome to most patients and according to some researchers may be indicative of small strokes or another type of brain damage. Some researchers have been concerned, although without any evidence, about possible accumulation of these lesions with progressive brain damage. A report in the June issue of Cephalalgia by Dr. Todd Rozen presents a case where a brain lesion seen on the first MRI scan was no longer seen on the second one 16 days later. We have always reassured our patients about the benign nature of these lesions, but it is good to have this additional evidence.

Migraines at the end of pregnancy and soon after the delivery increase the risk of strokes and other vascular complications (cerebro-vascular disease, or CVD). Dr. Bushnell and her colleagues presented these findings at the last annual meeting of the American Academy of Neurology. They looked at almost 17 million pregnancies and identified almost 34,000 women who had migraines. There was an increase in migraines with increased maternal age. Women who had migraines around the time of delivery were 19 times more likely to have a stroke, five times more likely to have a heart attack, three times more likely to have a pulmonary embolus, more than twice the risk of deep venous thrombosis, nearly four times he risk of thrombophilia, twice the risk of heart disease and more than twice the risk of preeclampsia/gestational hypertension.

About two thirds of women stop having migraines during their pregnancies, but if headaches are present at the end of pregnancy close observation is warranted. It is possible that magnesium supplementation as well as regular exercise, proper diet and other life style changes may help prevent these serious complications. Long-term risk for strokes and heart attacks is higher in women who keep additional weight gains after pregnancy.