"In this large, prospective cohort of women, active Migraine with aura was associated with increased risk of major CVD, myocardial infarction, ischemic stroke, and death due to ischemic CVD, as well as with coronary revascularization and angina. Active Migraine without aura was not associated with increased risk of any CVD event."
Analysis of and comments on the study
Dr. Richard Lipton and Dr. Marcelo Bigal reviewed the study by Kurth et al and evaluated possible reasons for the connection between Migraine with aura and CVD...
- They ruled out coincidence because the design of the study protects against bias and Kurth et al measured and adjusted for many CVD risk factors.
- Lipton and Bigal also ruled out the theory that the stress of Migraine attacks could "unmask coronary artery disease acutely or could contribute to the development of vasculopathy over the course of multiple headache attacks." If that were the case, one would expect the correlation in Migraine without aura as well as Migraine with aura, which was not the outcome of the study.
- The hypothesis of an environmental exposure was also ruled out because of the absence of correlation in Migraine without aura.
- Lipton and Bigal suggest that there may be a genetic link that predisposes people to both cardiovascular risk factors and Migraine with aura. A polymorphism (A variation that is too common to be due merely to new mutation) in gene C677T is associated with both increased risk of CVD and Migraine with aura, but not Migraine with out aura.
Lipton and Bigal commented,
"From a clinical perspective, most Migraine patients have Migraine without aura and, therefore, are not at increased risk of CVD. They can be reassured... For patients with Migraine with aura, clinicians should have heightened vigilance for modifiable cardiovascular risk factors, such as hypertension, hyperlipidemia, and smoking... Future studies should investigate the possibility that preventive medications for Migraine or antiplatelet therapy might reduce the risk of CVD in patients with Migraine with aura."
