Some migraine sufferers may be at an increased risk for brain lesions, according to the results of a new study. The findings, published today in the Journal of the American Medical Association, could indicate that the debilitating headache is, in certain cases, a progressive brain disease.

The study looked at 295 Dutch adults aged 30 to 60 who had migraines, some with visual disturbances (or aura, in the technical parlance) and others without, and 140 migraine-free control subjects. Using magnetic resonance imaging, researchers led by Mark C. Kruit of Leiden University Medical Center in the Netherlands scanned the participants¿ brains for cerebral infarction (tissue that has died from a lack of oxygen¿the result of a blood clot clogging an artery) and white-matter lesions. They found that the risk of infarction in patients with migraine without aura was seven times that of controls; patients who suffered migraine with aura had about 13 times the risk as compared with controls, with the risk increasing nearly 16 times for subjects who had attacks once a month or more.

In an accompanying editorial, Richard B. Lipton and Julie Pan of the Albert Einstein College of Medicine write that migraine "should be conceptualized not just as an episodic disorder but as a chronic-episodic and sometimes chronic progressive disorder." With a shift toward that way of thinking, they say, therapeutic strategies, too, may change. "If the brain lesions demonstrated by Kruit et al have a significant clinical correlate, preventing the accumulation of brain lesions may become an additional goal of treatment."

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