Long Term Effects of Chronic Migraine

Long Term Effects of Chronic Migraine

Written by Greg Bullock on 19th Oct 2019

For most, chronic migraine is a lifelong condition—one that follows patients throughout their years, carrying with it long-term symptoms and effects. Headache disorder advocate Jaime Sanders has had migraine since she was just two years old and describes its ongoing impact this way:

"I had to learn early on that I was different and couldn’t do all the things my friends could. I experienced stigma in school and had my pain diminished by teachers and peers. As an adult with migraine, I had to figure out how to manage being a mother and wife who had limitations."

And this is a common experience for those who live with the condition. In this post, we explore what is true and what is not regarding these future issues faced by those with migraine.

How Migraine Affects the Brain Over Time

Probably the question on every patient’s mind is whether or not chronic migraine can cause long-term changes or dysfunction within the brain. Do all those attacks associated with a chronic headache disorder harm the physical makeup of our brain over time? The answer is, at best, complicated.

Various studies have confirmed the presence of deep white matter lesions or abnormalities in the brain, which may be associated with an increased risk of stroke and/or cognitive decline.1,2 However, those who have migraine without aura as well as men with migraine may be less susceptible to this long-term damage, and it is unclear whether chronic migraine and/or higher attack frequency also enhances this risk.

In addition, although the physiological changes have been observed repeatedly, the outcomes connected with them are tentative. In fact, the idea that cognitive decline occurs at an accelerated rate in migraine patients over time remains highly controversial within the medical field.

Still, people with a primary headache disorder often attest that their thinking, attention and other mental functioning becomes affected before, during and/or after an acute migraine attack, but researchers have questioned whether permanent deficits occur. Several studies suggest there is no link between chronic migraine and persistent cognitive dysfunction, but findings have remained inconsistent over multiple investigations. And issues like co-morbid medication overuse and anxiety or depression may make these issues more of a reality for some.3-5

Although this type of mental decline may be unlikely, a history of migraine may increase a person’s risk for degenerative brain diseases such as Alzheimer’s disease or dementia later in life, say researchers.6 Interestingly, men may not have as significant a risk, but more study is needed in this area to verify whether this is truly accurate.

Long-Term Symptoms of Migraine

There is no cure for migraine, which means most with the disease will experience persistent, lifelong symptoms as part of their regular attacks. There can be dozens of migrainous features, but some of the most common include:

  • Headache
  • Photophobia/light sensitivity
  • Sensitivity to sound
  • Nausea
  • Vertigo
  • Dizziness

While it is difficult to pinpoint exactly how long these symptoms last—and outcomes naturally vary between patients—we can offer some insight. For example, our 2017 survey of light-sensitive subjects (both with and without migraine) showed that almost 50% had been dealing with the symptoms of their condition for at least 10 years. Another clinical study showed that people diagnosed with vestibular migraine initially presented with regular migraine attacks in their early 20’s, and yet they did not develop the dizziness-related symptoms until their late 30’s.7

In addition, migraine frequency and symptom presentation can change throughout a person’s lifespan, which makes age an important factor in the equation. For instance, many children with migraine and even adults report that their attacks become more regular and even evolve from episodic to chronic through their prime adulthood years.8,9 This may be the result of hormonal or other natural changes, but other risk factors (such as obesity and medication or opioid overuse) can also contribute to this progression.

Conversely, the number and intensity of attacks and related symptoms have been shown to decrease in later years, especially starting at 50 years old. Menopause, in particular, may contribute to significant changes for women with migraine.

Long Term Symptoms of Chronic Migraine Infographic

Ultimately, new symptoms can develop, long-standing problems can diminish, and the number of attacks can increase or decrease, no matter how long you have been living with chronic migraine.

Future Risk of Comorbid Disorders

Migraine has been perpetually linked to the onset of other conditions (known as comorbidities), which may or may not be a direct manifestation of the migrainous process. Some of these can continue into the later stages of life as well.

Anxiety, Depression and Panic Disorders

The early development of migraine, whether in childhood or as an adult, leads to higher instances of emotional and psychiatric disorders. Usually they occur and progress nearer to the initial diagnosis, but they also persist for years and even decades. Among the most likely are:

  • Depression: There are several studies discussing the strong association between major depression and migraine.10,11 Not only is it regularly present at two years after diagnosis, but patients may be 3-times more likely to develop it over the course of their lifetime. Sensory symptoms like photophobia can also increase the depression risk.

  • Anxiety and Panic Disorders: The presence of anxiety and panic disorders also remain associated with migraine, and patients have a noticeably-increased risk of having one or more of these concerns in the future.11

Stroke and Cardiovascular Disease

As we noted above, specific lesions or damage to the brain has been observed over the course of migraine progression. This may contribute to and explain the presence of cardiovascular disorders in the later stages of life. It is important to remember, however, that statistics still show these as rare occurrences even if there is a higher inherent risk.

  • Stroke: Those diagnosed with migraine with aura—particularly after the age of 50 years—have a particular concern for ischemic stroke later in life, according to researchers.12 Atrial fibrillation, or irregular heartbeat, has also been associated with migraine-related aura—which directly increases the likelihood of stroke.13 It’s also important to note that other non-aura migraine types and earlier development can lead to elevated stroke risk.

  • Other Cardiovascular Diseases: Findings remain inconsistent as to whether chronic migraine leads to coronary heart disease and hypertension (or high blood pressure).11 While the link is unclear, patients must still pay close attention to any changes in their heart functioning.

Movement disorders

  • Parkinson’s Disease: While the chances are quite small, a 2014 study noted a nearly two fold increase in the risk for the development of Parkinson’s disease associated with migraine with aura. Researchers suggest that both conditions share dopamine abnormalities in the brain, which may provide insight into why they co-occur.

  • Restless Leg Syndrome: People with migraine also describe the sensation of needing to move their legs and discomfort in their extremities as part of restless leg syndrome. Of note, patients with both conditions have greater light and sound sensitivity, dizziness and neck pain, among other symptoms.11

Socioeconomic Outcomes

As with any chronic medical condition, migraine may have a negative impact on a person’s daily experiences, including their socioeconomic status and quality of life.

Living with migraine often comes with unwanted or negative stigma. Oftentimes, patients struggle with the complexities of living with an invisible illness and struggle with shame, misdiagnosis, and less-than-optimal treatment. In many cases, migraine stigma spills into one's professional life. Co-workers and employers may not understand the chronic and painful nature of it and may think it is "just a bad headache." At times, inevitable absenteeism may result in job loss or having to leave work to go on disability.

For some, the financial and economic burden of the headache disorder can lead to increased health-related costs and loss of productivity in the workplace. In fact, medical expenses for those with migraine were approximately $6500 higher annually as opposed to their non-headache counterparts—mostly due to costs associated with hospitalization, emergency room visits and medications.14

Given this overall burden and the already-increased chance of developing depression or another emotional complications, it is unfortunately not surprising that research has shown a higher rate of suicidal ideation and attempts in those with migraine.15 We know it’s tough and can feel hopeless at times, but we want to emphasize that you are not alone. There are countless resources available to help you through the worst of it. And if you or a loved one are having thoughts of self harm, please call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255.

Important Other Considerations

It is important to understand that openly discussing the long term effects and complications of chronic migraine is not meant to scare or predict future outcomes for patients. Each person progresses in their own way and reacts differently to treatment, so being armed with accurate information is essential to getting the right care.

Treatment, diagnosis, and countless other factors can mediate or reduce the negative outcomes associated with migraine. Being open and honest about the disorder can not only empower patients but also be a tool for community education on migraine experiences.

If you are looking for additional support, click below to see a detailed list of resources available to patients. We hope they can help you better manage the challenges of chronic migraine.


Additional reading:

Migraine in Children and Adolescents

Migraine in Adulthood and Middle Age

Migraine in the Elderly


References:

1Palm-Meinders IH, Koppen H, Terwindt GM, et al. Structural brain changes in migraine. JAMA. 2012;308(18):1889–1897. doi:10.1001/jama.2012.14276.

2Erdélyi-Bótor S, Aradi M, Kamson DO, Kovács N, et al. Changes of migraine-related white matter hyperintensities after 3 years: a longitudinal MRI study. Headache. 2015 Jan;55(1):55-70. doi: 10.1111/head.12459. Epub 2014 Oct 16.

3Vuralli D, Ayata C, Bolay H. Cognitive dysfunction and migraine. J Headache Pain. 2018;19(1):109. Published 2018 Nov 15. doi:10.1186/s10194-018-0933-4

4Gaist D, Pedersen L, Madsen C, Tsiropoulos I, Bak S, Sindrup S, McGue M, Rasmussen BK, Christensen K. Long-term effects of migraine on cognitive function: a population-based study of Danish twins. Neurology. 2005 Feb 22;64(4):600-7.

5Cai X, Xu X, Zhang A, et al. Cognitive Decline in Chronic Migraine with Nonsteroid Anti-inflammation Drug Overuse: A Cross-Sectional Study. Pain Res Manag. 2019;2019:7307198. Published 2019 May 6.

6Morton RE, St John PD, Tyas SL. Migraine and the risk of all-cause dementia, Alzheimer's disease, and vascular dementia: A prospective cohort study in community-dwelling older adults. Int J Geriatr Psychiatry. 2019 Sep 4. doi: 10.1002/gps.5180. [Epub ahead of print].

7Teggi R, Colombo B, Albera R, Asprella Libonati G, Balzanelli C, Batuecas Caletrio A, et al. Clinical Features, Familial History, and Migraine Precursors in Patients With Definite Vestibular Migraine: The VM-Phenotypes Projects. Headache. 2018 Apr;58(4):534-544. doi: 10.1111/head.13240. Epub 2017 Dec 4.

8Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008 Sep;48(8):1157-68. doi: 10.1111/j.1526-4610.2008.01217.x.

9Straube A, Andreou A. Primary headaches during lifespan [published correction appears in J Headache Pain. 2019 Jun 19;20(1):71]. J Headache Pain. 2019;20(1):35. Published 2019 Apr 8. doi:10.1186/s10194-019-0985-0

10Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurology. 2003 Apr 22;60(8):1308-12.

11Wang SJ, Chen PK, Fuh JL. Comorbidities of migraine. Front Neurol. 2010;1:16. Published 2010 Aug 23. doi:10.3389/fneur.2010.00016.

12Androulakis XM, Sen S, Kodumuri N, Zhang T, Grego J, Rosamond W, Gottesman RF, Shahar E, Peterlin BL. Migraine Age of Onset and Association With Ischemic Stroke in Late Life: 20 Years Follow-Up in ARIC. Headache. 2019 Apr;59(4):556-566. doi: 10.1111/head.13468. Epub 2019 Jan 21.

13Sen S, Androulakis XM, Duda V, et al. Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study. Neurology. 2018;91(24):e2202–e2210. doi:10.1212/WNL.0000000000006650

14Bonafede M, Sapra S, Shah N, Tepper S, Cappell K, Desai P. Direct and indirect healthcare resource utilization and costs among migraine patients in the United States [published online February 15, 2018]. Headache. doi: 10.1111/head.13275

15Lin YK, Liang CS, Lee JT, et al. Association of Suicide Risk With Headache Frequency Among Migraine Patients With and Without Aura. Front Neurol. 2019;10:228. Published 2019 Mar 19. doi:10.3389/fneur.2019.00228

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