Thalassemia and white matter changes (WMCs) in the brain may be associated with greater likelihood of experiencing headache, according to a study published in the British Journal of Haematology.

Researchers assessed 82 patients with thalassemia and 80 age- and gender-matched individuals in a control arm. Patients underwent neurological evaluations, magnetic resonance imaging (MIRA), magnetic resonance angiography (MRA), and a cognitive functioning assessment.

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Significantly more patients with thalassemia reported experiencing recurring headaches compared with individuals in the control arm (61% vs 22.5%; P <.001). Migraine was the most common type of headache for both cohorts, accounting for 60% of headaches in patients with thalassemia and 82.3% of headaches in patients in the control arm.

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Observations of WMCs were not significantly different (P =.078) in patients with thalassemia (24.3% [20/82]) and individuals in the control arm who underwent MRI scanning (6.9% [2/29]). Of the patients with thalassemia who had WMCs, 14 had small lesions (smaller than 5 mm) only, 5 had large lesions (larger than 5 mm) only, and 1 had both small and large lesions. Most WMCs were found in the frontal and parietal lobes.

WMCs were not associated with differences in platelet count, hemoglobin concentration, or serum ferritin concentration. However, WMCs did appear to be correlated with headache; 34% of patients with headache exhibited WMCs, compared with 9% of patients without headache.

Reduced cognitive scores were reported by 50.6% of patients with thalassemia and 35.4% of individuals in the control arm (P <.079) and were not found to associate with hemoglobin level, WMCs (P =.823), changes in EEG (P =1.00), or headache (P =.576).

The authors noted that “postulating an etiology for headache or WMCs in patients with hemoglobinopathies is difficult” and that follow-up studies in larger populations to determine the clinical applicability of this data are warranted.


1.     Premawardhena A, Ranawaka U, Pilapitiya T, et al. Headache: an important symptom possibly linked to white matter lesions in thalassaemia [published online March 5, 2019]. Br J Haematol. doi:10.1111/bjh.15825