[Can migraine cause subclinical brain lesions? A Dutch study shows a connection--but more research is required]

There is general agreement that migraine a primary disease of the central nervous system with secondary vascular effects. In a recent study by Kruit and co-authors (JAMA 2004;291(4):427-34) it is reported that some individuals that experience migraine with and without aura may be at an increased risk for subclinical lesions in certain areas of the brain. The results are very interesting but have to be interpreted with caution. Needless to say, it is imperative that in the absence of scientific evidence, we do not further burden individuals with migraine with frightening information on the potentially poor prognosis of their disease. At the same time, it is equally important that we do not miss the opportunity to avoid possible risks for brain lesions by means of optimized symptomatic treatment of migraine attacks as well as preventive therapies. Accordingly, the need for more longitudinal and prospective migraine research is immense. The aim of the future migraine research should be to obtain more information about the natural course of migraine as well as evaluate the association between migraine and cerebral WMLs and their consequences. The results generated in future studies may prove very important, not least with respect to future allocation of health care resources. Future studies will hopefully provide correct answers to most questions about migraine and constitute a basis for improved care of migraine sufferers with optimal use of the different treatment options as well as offer promising treatment strategies to prevent disease progression, including risk factor modification, optimized symptomatic treatment of migraine attacks and preventive therapies.