Abstract
BackgroundPrevious studies found an association between migraine and dementia, which are two leading causes of disability. However, these studies did not differentiate between migraine types and did not investigate all prevalent dementia subtypes. The main objective of this national register-based study was to investigate whether migraine was a risk factor for dementia. Additionally, we explored potential differences in dementia risk for migraine with and without aura.MethodsWe obtained data on birth cohorts born between 1935 and 1956 (n = 1,657,890) from Danish national registers. Individuals registered with migraine before age 59 (n = 18,135) were matched (1:5) on sex and birthdate with individuals without migraine (n = 1,378,346). Migraine was defined by International Classification of Diseases (ICD) diagnoses and dementia was defined by ICD diagnoses and anti-dementia medication. After matching, 62,578 individuals were eligible for analysis. For the statistical analyses, we used Cox regression models and adjusted for socio-demographic factors and several psychiatric and somatic morbidities.ResultsDuring a median follow-up time of 6.9 (IQR: 3.6–11.2) years, 207 individuals with migraine developed dementia. Compared with individuals without migraine, we found a 50% higher rate of dementia among individuals with migraine (HR = 1.50; 95% CI: 1.28–1.76). Individuals without aura had a 19% higher rate of dementia (HR = 1.19; 95% CI: 0.84–1.70), and individuals with aura had a two times higher rate of dementia (HR = 2.11; 95% CI: 1.48–3.00).ConclusionsOur findings support the hypothesis that migraine is a midlife risk factor for dementia in later life. The higher rate of dementia in individuals with a hospital-based diagnosis of migraine with aura emphasizes the need for studies on pathological mechanisms and potential preventative measures. Furthermore, given that only hospital-based migraine diagnoses were included in this study, future research should also investigate migraine cases derived from the primary healthcare system to include less severe migraine cases.
Highlights
Previous studies found an association between migraine and dementia, which are two leading causes of disability
Because migraine diagnosis criteria was defined with the establishment of the International Classification of Headache Disorders (ICHD) in 1988 [21] and since incorporated in the International Classification of Diseases (ICD) [22], migraine information was included from 1988 to increase exposure assessment validity
Statistical analyses Using frequency analyses, we investigated the distribution of socio-demographic factors, headache, psychiatric morbidities and Charlson Comorbidity Index (CCI) among individuals with and without migraine
Summary
Previous studies found an association between migraine and dementia, which are two leading causes of disability. These studies did not differentiate between migraine types and did not investigate all prevalent dementia subtypes. The main objective of this national register-based study was to investigate whether migraine was a risk factor for dementia. Migraine and dementia are among the most prevalent neurological disorders and leading causes of disability [1]. Previous epidemiological studies reported a positive association between migraine and Alzheimer’s disease (AD), vascular dementia (VaD) and unspecified dementia [4,5,6,7,8]. The exact pathophysiological links between migraine and dementia are unknown, but mechanisms may include vascular disease and changes, increased amyloid plaque formation, inflammation, and deficits in nerve growth factors due to comorbid depression, increased cortisol levels due to psychological stress, brain structural changes in overlapping pain and memory networks [10], cardiovascularand cerebrovascular events due to stroke and myocardial infarction [11], and structural brain abnormalities [12]
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