Migraine Risks - Some Perspective

The transcript of this podcast is below. If you prefer to listen to it, you can easily do so from the MigraineCast Web site.

Hello and welcome to MigraineCast.

Over the last few years, we've seen research statistics demonstrating that having Migraine disease increases our risks of other health problems such as stroke, cardiovascular disease, and brain damage. The mainstream news media and some bloggers have reported these findings with sensationalized headlines that had people in a panic running to their doctors in fear. You're bound to have seen headlines such as "Stroke Risk Doubles for Migraine Sufferers."

On the other end of the spectrum, on the rare occasions when Migraine sufferers are shown to possibly have a lower risk for another health issue, the media and those bloggers come up with headlines that sound as if having Migraines will save our lives or are really a good thing - headlines such as "Migraine's Silver Lining" or "Migraines Prevent Breast cancer!"

I think not!

So, where does the truth lie? Usually somewhere between "The Sky Is Falling" and "Enduring World Peace Achieved."

Let's take a look at some of these reported risks and supposed benefits of having Migraine disease and put them in perspective:

• Migraine and stroke risk: For many years, there was a great deal of debate about whether having Migraines increases our risk of stroke. When multiple studies were reviewed and the smoke settled, the answer was, "Yes." And, yes, having Migraines does double our risk of stroke. BUT if you look at what the so-called normal risk of stroke is, and double it, it's still nothing to panic over. In reality, you're more likely to have a stroke as a result of smoking. The average prevalence of stroke in women is 9 per 100,000. The studies showed women with Migraine to have 2.16 times greater risk than non-Migraineurs. That's still only about 20 out of 100,000.

• Migraine and cardiovascular disease in women: Studies have also shown that women who have Migraine with aura are at increased risk of cardiovascular disease. This risk translates to 18 major cardiovascular events attributable to Migraine with aura per 10,000 women per year. Not great if you have one of those 18 events, but still, not a huge number.

• Migraine and cardiovascular disease in men: The results of studies of men were similar to the studies of women. Dr. Tobias Kurth, the lead investigator, commented, "The attributable risk is fairly low, so I think people should certainly not panic if they have a Migraine attack that they’ll have a heart attack the next day. We know much more about major risk factors and we should certainly emphasize and modify those. At this point, there’s no data that would support to change any treatment of Migraine or anything else for Migraineurs at this point."

• Migraine and brain damage: In this case, studies demonstrated that Migraineurs who have three or more Migraines a month showed significantly more abnormalities than those with fewer Migraines, and that people with a history of Migraine for more than 15 years had more changes in the brain than those with a shorter history of Migraine. First, the "damaged" areas of the brain, at this point, have been termed "silent." There are areas where the brain tissue is damaged, but if that damage is producing symptoms, those symptoms have yet to be identified. Second, there's more and more that can be done to reduce the frequency of our Migraines.

• Migraine Decreases Risk of Breast Cancer: Well, maybe not. From one small study, the researchers made the bold statement, "Migraine lowers the risk of breast cancer by 30%." That's what most of the headlines read. However, several leading Migraine researchers disagree, and I have trouble putting much stock in the study results myself. Identifying the Migraineurs in the study was based solely on the women saying they had Migraines. There was no official diagnosis involved. Some of them may not have had Migraines; some who didn't say they had Migraines may have. The researchers put far too much emphasis on the role of estrogen fluctuation. Yes, estrogen fluctuations around menses, pregnancy, and menopause are triggers for some women. However, this does not hold true for all women. For some women, those estrogen fluctuations are not a trigger. Again, this makes it difficult to consider the data valid.

So, let's add a bit more perspective and reason to the risk issues. In all four of the issues I've discussed here, we're not really helpless. There's a great deal we can do to reduce our risks of stroke and cardiovascular disease. Nutrition, exercise, proper rest, not smoking, not using oral contraceptives. All of those are modifiable risk factors -- factors we can influence and, at least to some extent, control. None of the evidence is reason to panic. It IS reason to have a productive conversation with our doctors about reducing our risks... and then following up on the recommendations.