Migraine Linked to Higher Risk for Alzheimer Disease and Other Dementias

Migraine is associated with a significantly increased risk for all-cause dementia, Alzheimer disease (AD), and vascular dementia (VaD), particularly among women and patients who have migraine with aura, according to results of a systematic review and meta-analysis published in The Journal of Headache and Pain.

Investigators searched 6 databases from inception up to December 1, 2024 to evaluate dementia risk in patients with migraine. They evaluated cohort studies that assessed risk for dementia in patients with migraine vs control individuals with no history of migraine or headache. Meta-analyses were performed using random-effects or fixed-effects models based on heterogeneity, with subgroup analyses performed to identify potential sources of heterogeneity.

A total of 11 high-quality cohort studies published between 2014 and 2024 were included in the final analysis, representing 272,765 patients in the migraine group and 6,691,588 patients in the control group. These studies were conducted in Europe (6 studies), East Asia (4 studies), and the United States (1 study). All included men and women and used validated migraine diagnostic criteria. Among the 11 studies, 7 assessed all-cause dementia, 4 assessed AD, and 5 assessed VaD.

Results of the meta-analysis revealed migraine was associated with an increased risk for all-cause dementia (hazard ratio [HR], 1.26; 95% CI, 1.09-1.46; I²=84.5%). Subgroup analyses indicated elevated risk in Asian populations (HR, 1.59; 95% CI, 1.04-2.42; I²=91.8%), women (HR, 1.28; 95% CI, 1.12-1.47; I²=62.6%), and patients with migraine with aura (HR, 1.22; 95% CI, 1.03-1.44; I²=38.6%). Risk for dementia was not greater in migraine without aura.

Studies using International Classification of Diseases criteria showed a higher risk for dementia in patients with migraine (HR, 1.38; 95% CI, 1.18-1.62; I²=82.2%), whereas studies using Diagnostic and Statistical Manual of Mental Disorders criteria did not (HR, 0.99; 95% CI, 0.83-1.18; I²=23.8%). Risk for dementia in the setting of migraine was also elevated in high-quality studies and in studies with more than 2000 patients. Meta-regression analysis found no significant sources of heterogeneity.

Among 4 studies highlighting AD risk, there was a significantly increased risk for dementia in patients with migraine (HR, 1.48; 95% CI, 1.31-1.67; I²=90.9%). After removal of an outlier study that lacked adjustments for key confounders, dementia risk remained elevated (HR, 1.32; 95% CI, 1.26-1.38; I²=55.3%). Five studies reporting VaD risk showed a significant association between migraine and dementia with low heterogeneity (HR, 1.28; 95% CI, 1.24-1.32; I²=27.6%), although Egger’s test indicated publication bias (P =.048).

Study limitations include potential population bias, which limits generalizability of the findings, high heterogeneity among studies, differences in adjusted HR values owing to the different covariates, and lack of adjustment for certain confounding factors (such as depression, sleep, hypertension) in some studies that may affect dementia risk in patients with migraine.

The investigators concluded, “Despite limitations, our results suggest migraine may be one of the risk factors for dementia, and their relationship merits further exploration.”

This article originally appeared on Clinical Pain Advisor