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Headache NewsBlog By Headache Specialist Alexander Mauskop

Alexander Mauskop, director of the New York Headache Center, regularly posts his thoughts on current headache news on the aptly named Headache NewsBlog. He dispels myths and examines closely media coverage of headache news. Here’s a taste of Mauskop’s blog, but look over Headache NewsBlog to get the full flavor.

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Reinterpreting Study on Migraine & Brain Damage

Headache specialist Dr. Christina Peterson‘s comment on Migraines Linked With Brain Damage points out that one study never reveals absolute truth. Nor are articles written for the general public usually preceeded by the analysis necessary to critically evaluate research findings. As Dr. Peterson writes, it is “distressing and somewhat irresponsible that every finding in the medical literature becomes a sound bite for the media.”

“For anyone who thinks the information presented here is condescending–please note that most of what Kerrie has put forward here has been written by journalists, and
not by medical experts
. It has been paraphrased from the original medical studies. I personally find it distressing and somewhat irresponsible that every finding in the medical literature becomes a sound bite for the media.

“It is the unfortunate fact that not every study can be taken as absolute gospel truth. This is why we call our ideas “hypotheses,” and we set up studies to test our hypotheses. Generally speaking, we consider them to be working hypotheses until newer ideas are discovered to expand our understanding of the concept. And even then, we are not
fully comfortable until new findings are confirmed by several studies.

“A good chunk of what we are taught in the early part of medical school is how to interpret studies in the medical literature–how to analyze the validity of study design, how to be certain the statistical analysis was done correctly, and how to tell if a given study actually measured anything that matters.

“There are a number of issues presented here. White matter lesions (those white spots on MRI scans that some migraineurs get) may or may not reflect anything to do with brain damage. We do not know yet. However, there was a paper presented this past week in Boston at the Academy of Neurology meeting that suggests not. But I would want to see
further confirmation before I would be certain about anything. White matter lesions, however, are unlikely to cause cognitive damage, as it is the gray matter that does the thinking.

In the study that suggests “older” migraine sufferers have no cognitive decline–this was determined by conducting a 10 minute test called the Mini-Mental Status Exam, which is not particularly rigorous testing. Genetic material was also collected for a test called APOE4, which has been associated with Alzheimer’s. However, very recent research conducted at Yale has demonstrated that the APOE4 genetic allele is associated with psychosis in Alzheimer’s, and not with cognitive decline or loss of function. (The migraine researchers could not have known that when they began their study some years ago.)

“In Boston, I saw microscopy pictures of blood vessels, brain cells, and receptors specially stained to show what happens during cortical spreading depression. This was research done at Harvard-MIT. It was fairly clear that there is oxygen loss in the cellular areas in between the capillaries during cortical spreading depression (CSD). Does this
cause cognitive loss? We don’t know.
The type of researcher who looks at cellular and subcellular structures is generally not the same type of researcher who studies cognitive responses in a whole person.

“Research can be excruciatingly slow. We have, for example, known about CSD since the 1930s, but it took time before it was proven to be associated with migraine, and even longer before we have been able to more clearly understand its significance. We are only now learning exactly what happens chemically during CSD.

“The take-home message is that not everyone with migraine is the same, and that, NO–it’s NOT JUST A HEADACHE!

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Migraines Linked With Brain Damage

As brain cells swell during a migraine, they become starved of oxygen, which may cause brain damage — at least in rats — according to a newly released study. This damage may help explain other findings that people with migraine have a higher risk of stroke. Here’s an excerpt of the article on brain damage and migraine:

“They studied a process called cortical spreading depression, known as CSD, a wave of changes in cells associated with migraine, stroke and head trauma.

“They used a precise two-photon microscopic and oxygen sensor microelectrodes to look at the brains of live mice while they caused this process.

“They saw a swelling occur and the brain cells became starved of oxygen. The nerve cells were damaged — specifically the dendrites, the long, thin spikes that stretch from one nerve cell to another.”

This highlights the importance of using preventives rather than just painkillers during a migraine. Not having a migraine at all prevents other symptoms and the potential for brain damage. In contrast, painkillers treat the pain, they don’t keep the migraine from wreaking havoc on the brain. I’m not sure where triptans fall on this scale, but certainly aborting a migraine is better than having one.

Some good may come from having migraine. A study released last week found that migraine sufferers show less cognitive decline and memory loss than those without migraine.

However, that good news is muddied by other studies showing that people with migraine suffer from brain changes and a risk of brain lesions. Not to mention another new study noted an increased risk of cardiovascular disease.

How much more will it take for people to see that migraine isn’t just about headaches?