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Headache, migraine, and structural brain lesions and function: population based Epidemiology of Vascular Ageing-MRI study

BMJ 2011; 342 doi: (Published 18 January 2011) Cite this as: BMJ 2011;342:c7357
  1. Tobias Kurth, director of research123,
  2. Shajahal Mohamed, fellow1,
  3. Pauline Maillard, researcher4,
  4. Yi-Cheng Zhu, neurologist1256,
  5. Hugues Chabriat, professor of neurology57,
  6. Bernard Mazoyer, professor of radiology48910,
  7. Marie-Germaine Bousser, professor of neurology57,
  8. Carole Dufouil, senior researcher12,
  9. Christophe Tzourio, senior director of research125
  1. 1INSERM Unit 708—Neuroepidemiology, Paris, France
  2. 2UPMC Université Paris 06, UMR_S708, Paris, France
  3. 3Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  4. 4CNRS-CEA UMR 6194 Groupe d’Imagerie Neurofonctionnelle, Caen, France
  5. 5Service de Neurologie, Groupe Hospitalier Lariboisière-Fernand-Widal, Assistance Publique Hôpitaux de Paris, Paris, France
  6. 6Department of Neurology, Peking Union Medical College Hospital, Beijing, China
  7. 7Université Paris Denis Diderot, Paris, France
  8. 8Université de Caen Basse-Normande, Caen, France
  9. 9Centre Hospitalier et Universitaire de Caen, Caen, France
  10. 10Institut Universitaire de France, Paris, France
  1. Correspondence to: T Kurth, INSERM Unit 708—Neuroepidemiology, Hôpital de la Pitié-Salpêtrière, 47 boulevard de l’Hôpital, 75651, Paris, Cedex 13, France tobias.kurth{at}
  • Accepted 12 October 2010


Objective To evaluate the association of overall and specific headaches with volume of white matter hyperintensities, brain infarcts, and cognition.

Design Population based, cross sectional study.

Setting Epidemiology of Vascular Ageing study, Nantes, France.

Participants 780 participants (mean age 69, 58.5% women) with detailed headache assessment.

Main outcome measures Brain scans were evaluated for volume of white matter hyperintensities (by fully automated imaging processing) and for classification of infarcts (by visual reading with a standardised assessment grid). Cognitive function was assessed by a battery of tests including the mini-mental state examination.

Results 163 (20.9%) participants reported a history of severe headache and 116 had migraine, of whom 17 (14.7%) reported aura symptoms. An association was found between any history of severe headache and increasing volume of white matter hyperintensities. The adjusted odds ratio of being in the highest third for total volume of white matter hyperintensities was 2.0 (95% confidence interval 1.3 to 3.1, P for trend 0.002) for participants with any history of severe headache when compared with participants without severe headache being in the lowest third. The association pattern was similar for all headache types. Migraine with aura was the only headache type strongly associated with volume of deep white matter hyperintensities (highest third odds ratio 12.4, 1.6 to 99.4, P for trend 0.005) and with brain infarcts (3.4, 1.2 to 9.3). The location of infarcts was predominantly outside the cerebellum and brain stem. Evidence was lacking for cognitive impairment for any headache type with or without brain lesions.

Conclusions In this population based study, any history of severe headache was associated with an increased volume of white matter hyperintensities. Migraine with aura was the only headache type associated with brain infarcts. Evidence that headache of any type by itself or in combination with brain lesions was associated with cognitive impairment was lacking.


  • Contributors: TK conceived and designed the study, analysed the data, and drafted the manuscript. He is guarantor. CT, PM, Y-CZ, and BM acquired the data. All authors interpreted the data, critically revised the draft for important intellectual content, and gave final approval of the version to be published.

  • Funding: The Epidemiology of Vascular Ageing study was carried out under an agreement between INSERM (Institut National de la Santé et de la Recherche Médicale); Merck, Sharp, and Dohme—Chibret Laboratories (West Point, PA); and EISAI (Paris, France). This study was supported by a chair of excellence grant of the French National Research Agency (ANR, Agence Nationale de la Recherche) to TK. The sponsors were not involved in the design, data collection, analysis, or interpretation of the study nor were they involved in writing the manuscript.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: that for the specific matter of this research, no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. Other declared interests: TK has received research funds from the US National Institutes of Health, the French National Research Agency (Agence Nationale de la Recherche, ANR), Merck, Migraine Research Foundation, and Parkinson’s Disease Foundation; is a consultant to i3 Drug Safety and World Health Information Science Consultants, LLC; and has received honorariums from Genzyme, Merck, and Pfizer for lectures. Y-CZ is funded by the French Chinese Foundation for Science and Applications (FFCSA), the China Scholarship Council, and the Association de Recherche en Neurologie Vasculaire (ARNEVA). HC has received fees from Eisai, Lundbeck, Servier, and Johnson and Johnson for participating on data safety or scientific committees. M-GB has received research support from Sanofi-Synthelabo and Servier. CD has received consulting fees from EISAI. CT has received research funding from the French National Research Agency (ANR) and is receiving fees from Sanofi-Synthelabo for participating in a data safety monitoring board and from Merck, Sharp, and Dohme and Servier for participating in scientific committees.

  • Ethical approval: This study was approved by the ethics committee of the Hôpital de Kremlin-Bicêtre.

  • Data sharing: No additional data available.

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