Migraine Plus Hypertension Equal Increased Stroke Risk
An Italian study has shown that people who have both Migraines and hypertension have a higher probability of cerebrovascular events than patients with hypertension alone.
In a session on Migraine and hypertension at the European Society of Hypertension European Meeting on Hypertension in Milan, Dr. Enrico Agabiti-Resei stated:
"The prevalence of hypertension and migraine comorbidity is clinically rare, but doctors should pay attention when they see this, because it might help identify patients at risk of an event. Migraine might be considered as a factor to be included in the score for risk of stroke."1
In an interview, he commented,
"When a young person has hypertension it's important, particularly if it's a woman, to look for the possible presence of migraine. Once comorbidity is found, it's very important to make an appropriate screening of cardiovascular risk factors, because what a doctor can do is try to reduce as much as possible these risk factors that are correctable by treatment — this includes not only hypertension but also high cholesterol, diabetes, and so on... We need more studies in order to assess the true importance of this relationship. We need prospective studies to confirm this interesting result."1
- The MIRACLES study was a multicenter, cross-sectional survey that included 2,973 participants with an established diagnosis of hypertension or Migraine in general practitioner's practices in Italy.
- 517 (17%) participants had both hypertension and Migraine (comorbidity group).
- 1,271 (43%) participants had hypertension only.
- 1,184 (40%) had Migraine only.
In the comorbidity group:
- The onset of comorbidity (having both conditions) occurred at around 45 years of age.
- Migraine started significantly later than it did in the Migraine-only group.
- Hypertension started significantly earlier it did in the hypertension-only group.
- A family history of Migraine or hypertension was very common and significantly higher than in the other two groups.
- There was a higher prevalence of history of cerebrovascular events - stroke and transient ischemic attack (TIA).
- In patients without other recognized risk factors for stroke, stroke and TIA occurred more frequently than in the hypertension group.
"In conclusion, results from this large cross-sectional study indicate that the prevalence of hypertension–migraine comorbidity is clinically relevant in general practice and that information on the comorbidity might help to identify patients at risk for cerebrovascular events. Clinicians should have heightened vigilance for modifiable risk factors in the comorbidity patients. Migraine might be considered as a risk factor to be included in the scores for the risk of stroke. It should be emphasized that the MIRACLES study has also educational implications because it may contribute to spread knowledge of the criteria for an appropriate diagnosis of hypertension and migraine, and to improve the cooperation between specialist centers and GPs for the related therapeutic procedures. It would obviously be important to determine whether migraine is itself a modifiable risk factor for stroke and if medications for migraine might reduce the risk of stroke in migraine patients with hypertension."2
Summary and comments:
The finding that there was a higher prevalence of history of cerebrovascular events - stroke and transient ischemic attack (TIA) - in the participants with both hypertension and Migraine is significant, but is not reason for panic. What it does tell us is that those of us with this comorbidity need to talk with our doctors about reducing our modifiable risk factors for stroke and be vigilant in working to reduce those risks.
Those of us with both hypertension and Migraine who need preventive treatment would do well to discuss with our doctors the possible use of medications to treat hypertension to do double duty as Migraine preventives as well.
If you have both hypertension and Migraine, discuss your stroke risk factors with your doctor. Be sure to consider:
- oral contraceptives,
- other risk factors mentioned by your doctor.
- Migraine and Stroke Risk
- Migraine Disease Linked to Cardiovascular Disease in Men
- Migraine with Aura Linked To Cardiovascular Disease in Women
- More Research Links Migraine With Aura and Stroke in Women
- When to See a Doctor for a Migraine or Headache
- Migraine and Cardiovascular Disease Risks – Dangerous?
- Is Migraine a Progressive Brain Disease?
1 Nainggolan, Lisa. "Migraine could be risk factor for stroke." HeartWire. TheHeart.org. June 20, 2011.
2 Mancia, Guiseppe; Rosei, Enrico Agabiti; Ambrosioni, Etorre; Avino, Francesco, Carolei, Antonio; Daccò, Maurizio; Di Giacomo, Giovanni; Ferri, Claudio; Grazioli, Irene; Melzi, Gabriella; Nappri, Guiseppe; Pinessi, Lorenzo; Sandrini, Giorgio; Trimarco, Bruno; Zanchin, Giorgio; on behalf of the MIRACLES study group. "Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence from a large, multicenter, cross-sectional survey in Italy (MIRACLES study)." Journal of Hypertension 2011, 29:309–318..
Medical review by John Claude Krusz, PhD, MD