Is Migraine a Progressive Brain Disease?

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Abstract
In this issue of THE JOURNAL, Kruit and colleagues1 provide important new data on the prevalence of brain infarction and white matter lesions in persons with migraine. The authors systematically recruited individuals with migraine with aura and migraine without aura as well as group-matched controls without migraine from the general Dutch population. By using population surveys, the authors identified a representative sample of migraine cases, addressing concerns about selection bias in earlier studies.2-4 An appropriate population control group without migraine was recruited from the screened sample. The use of 3-mm magnetic resonance imaging (MRI) sections improved lesion detection, and imaging studies were interpreted masked to case status, minimizing bias in the assessment of radiographic findings. Demographic factors, cardiovascular diseases, headache features, and treatment patterns were carefully assessed so that these potential confounders and effect modifiers could be taken into account.