Migraine and Alzheimer’s Disease

Written by: Kylie Petrarca, RN, BSN

Medically Reviewed by: Andrea D. Murphy, MSN, APRN, ANP-BC, NEA-BC

Edited by: Melissa Calise and Leigh Serth

Dementia vs Alzheimer’s Disease

Dementia is not a disease, rather a general term used to describe the abnormal changes that occur in the brain that result in problems with thinking, memory and problem solving.¹ The most common type of dementia is Alzheimer’s disease (AD) but there are many other types such as vascular, Lewey-body, frontotemporal and mixed.

It is unknown why Alzheimer’s disease occurs but experts believe it is caused by the build up of abnormal proteins called amyloid plaques and neurofibrillary tangles in the brain.^2,3 These proteins interfere with communication between nerve cells and ultimately result in cell death in various areas of the brain.^2,3 The hippocampus and entorhinal cortex, two areas of the brain involved in memory, are typically affected first.² Then, it affects other areas such as the cerebral cortex which is responsible for language, decision making, emotions and more.² 

Symptoms of Alzheimer’s disease vary based on stage (mild, moderate, severe) and the area of the brain that is affected but can include: difficulty remembering newly learned information, slowed thinking, memory loss, confusion, mood and behavior changes as well as changes in sleep and/or personality and more.⁴

The Connection Between Migraine and Alzheimer’s Disease

A 2001 study examining the risk factors for Alzheimer’s disease found that men and women with a history of migraine were three times more likely to develop AD.⁵ Looking at women alone, the study found that they were almost 6 times more likely to develop AD.⁵ 

Another study was conducted to determine if migraine was a risk factor for dementia subtypes; Alzheimer’s and vascular. The study found that a history of migraine was noted in 23.5% of participants with AD compared to 9.9% of cognitively intact participants.⁶ They also found that people with a history of migraine were three times more likely to have dementia than people without dementia.⁶ Similar to the previous study, they found that people with AD were four times more likely to have a history of migraine disease.⁶ Interestingly, when looking at the subtypes of dementia, they found no correlation with a history of migraine and vascular dementia.⁶ 

A third study of 7,454 people in the UK found that 5.2% of people with migraine and 3.7% of those without migraine were diagnosed with dementia.⁷ There was an association between migraine and Alzheimer’s disease however, the results were only significant for women.⁷

Commonalities Between Migraine and Alzheimer’s Disease

• Women are two to three times more likely to have migraine attacks and one and a half times more likely to develop Alzheimer’s disease compared to men.⁸
• Neurological complications after a traumatic brain injury (TBI) can result in migrainous symptoms and TBI is a risk factor for the development of Alzheimer’s disease later in life.⁹ 
• Both diseases are more likely to occur if there is a family history.⁸
• White matter lesions may be present on neuroimaging for both diseases. It is unknown why these lesions occur in people with migraine but subcortical white matter lesions are a risk factor for migraine chronification. It is important to note, not all white matter lesions are caused by a disease or lead to Alzheimer’s disease. White matter lesions are also a risk factor for Alzheimer’s disease and progression of the lesions is concerning for Alzheimer’s disease.^10,11
• Comorbidities shared among Alzheimer’s disease and migraine include patent foramen ovale, depression and inflammatory bowel disease.¹²

Treatments for Alzheimer’s Disease

Unfortunately, there is not a cure for Alzheimer’s disease, but a new intravenous medication called aducanumab was recently FDA-approved as the first treatment for Alzheimer’s disease. This medication removes beta-amyloid, a protein that is thought to cause AD.¹³ However, there is controversy about this medication due to the lack of efficacy of the medication improving cognition in clinical trials. Learn more.

Additionally, a class of medications known as the cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) help to treat AD symptoms such as impaired memory and thinking.¹³ 

A medication option that is used for migraine and Alzheimer’s disease is memantine. This medication is FDA-approved for moderate to severe AD and helps to improve the symptoms of Alzheimer’s including memory, language and the ability to perform simple tasks.¹³ Memantine is used off-label as a preventive treatment for migraine, meaning that it is not FDA-approved for migraine but is still prescribed to help relieve symptoms. To learn more about migraine treatments, click here.

What Type of Doctor Should I See for Migraine and Alzheimer’s Disease? 

A primary care provider can diagnose and treat migraine as well as Alzheimer’s disease. People over 65 years old may opt to see a geriatrician which is a primary care doctor that specializes in treating older adults. However, a primary care provider may refer a person with either disease to a neurologist for further evaluation. For someone with migraine, it is best to check if the clinician has additional training in primary headache disorders like migraine. There are also neurologists who specialize in memory care. 

A Note To Patients and Providers

Although Alzheimer’s disease and migraine are comorbid, there are preventive ways to reduce the risk of developing AD. Eating a healthy diet, exercising regularly and maintaining social connections are all ways to help prevent AD.¹⁴ A new onset of migraine-like symptoms in someone over 50 years old should be reported to a healthcare provider for further evaluation. For someone that has migraine and AD, a clinician could consider prescribing memantine to help with symptom management of AD and reduce migraine attacks. There is more to learn about the relationship between migraine and AD, therefore we encourage you to take part in clinical trials to advance the understanding of both diseases. Participate in clinical trials through TrialMatch by the Alzheimer’s Association or visit clinicaltrials.gov. Brain donation is also another option for people who have Alzheimer’s disease and/or migraine that want to contribute to research. Learn more about brain donation through the Brain Donor Project. 

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Resources 

1. What is Dementia?
2. Treatments for Dementia
3. Can Alzheimer’s be Prevented?
4. TrialMatch: Find Clinical Trials for Alzheimer’s and Other Dementia

References

1. Minen MT, Begasse De Dhaem O, Kroon Van Diest A, et al. Migraine and its psychiatric comorbidities. Journal of Neurology, Neurosurgery & Psychiatry 2016;87:741-749.
2. https://www.livescience.com/10728-headache-modern-life-hurts.html
3. Faravelli C, Lo Sauro C, Godini L, Lelli L, Benni L, Pietrini F, Lazzeretti L, Talamba GA, Fioravanti G, Ricca V. Childhood stressful events, HPA axis and anxiety disorders. World J Psychiatry. 2012 Feb 22;2(1):13-25. doi: 10.5498/wjp.v2.i1.13. PMID: 24175164; PMCID: PMC3782172.
4. Aggarwal M, Puri V, Puri S. Serotonin and CGRP in migraine. Ann Neurosci. 2012 Apr;19(2):88-94. doi: 10.5214/ans.0972.7531.12190210. PMID: 25205974; PMCID: PMC4117050.
5. https://americanheadachesociety.org/news/posttraumatic-headaches-persist-five-years-after-traumatic-brain-injury/
6. https://www.liebertpub.com/doi/abs/10.1089/neu.2014.3504
7. Lampl, C., Thomas, H., Tassorelli, C. et al. Headache, depression and anxiety: associations in the Eurolight project. J Headache Pain 17, 59 (2016). https://doi.org/10.1186/s10194-016-0649-2
8. Ailani, J, Burch, RC, Robbins, MS; the Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021; 61: 1021– 1039. https://doi.org/10.1111/head.14153
9. Pesa, J. and Lage, M.J. (2004), The Medical Costs of Migraine and Comorbid Anxiety and Depression. Headache: The Journal of Head and Face Pain, 44: 562-570. https://doi.org/10.1111/j.1526-4610.2004.446004.x

*The contents of this blog are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The writer does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.