It's a double-edged Migraine sword. Researchers have identified a gene that may lessen the risk of Migraine with aura (MWA), but for women who have MWA and carry the MTHFR 677TT genotype, the risk of ischemic stroke is substantially increased. This news comes from study findings reported in the July 30, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology.
This finding is based upon further analysis of data obtained in the Women's Health Study. In this study, 4,577 women had a history of Migraine. Of those women, 3.226 were actively experiencing Migraine and 39% of those had Migraine with aura (MWA). The women were also tested for a certain gene variant in the methyleneterahydrofolate reductase gene. Study participants were followed for a period of 12 years for the occurrence of cardiovascular disease, including heart attacks and ischemic stroke.
The study found that women who had both the gene variant and migraine with aura had more than three times the risk of cardiovascular disease, which was driven by four times the risk for stroke compared with women who did not have the gene variant and no history of migraine. An estimated 11 percent of the study population carries the gene variant.
These findings would logically Bring women to wonder about genetic testing, but the study authors say it's too early:
"This gene by itself does not appear to increase the risk for overall and for specific cardiovascular disease, but rather this research suggests a possible connection between the gene variant and migraine with aura. While it is too early to start testing young women with migraine with aura for this gene variant, more focused research will help us to understand these complex links and will help us to potentially develop preventative strategies... Doctors should try to reduce heart disease risk factors and advise young women who experience migraine with aura not to smoke and to consider birth control pill alternatives as these increase the risk of ischemic vascular problems."
study author Tobias Kurth, MD, ScD Brigham and Women's Hospital and Harvard Medical School, Boston
Since the study only looked at women, it's not known if the results would be the same in men.
Summary and comments: As with other studies that have shown a correlation between Migraine and stroke, this one gives reason for thought and caution, but not panic. If you have Migraine with aura, speak with your doctor about how you can reduce stroke risk factors. Work with your doctor toward the best Migraine treatment regimen for you. Develop nutrition and exercise lifestyle habits that will benefit your overall state of health. And, keep learning. The more we know about our health and issues such as Migraine disease, the more we can do to reduce our risks.
The closing paragraph of the Neurology article is worth special note:
"Our results warrant replication in other large cohorts with information on migraine and aura status according to the IHS criteria. In particular, age- and gender specific effects need to be considered. Given the limited knowledge about the biologic pathways involved between migraine with aura and ischemic vascular events, genetic testing of migraineurs with aura seems premature. However, practitioners should focus on reducing cardiovascular risk factors and particularly advise young women with migraine with aura not to smoke and to re-evaluate oral contraceptive use."
Schürks, Markus, MD, MSc; Zee, Robert Y.L., MD, PhD; Buring, Julie E., ScD; Kurth, Tobias, MD, ScD. "Interrelationships among the MTHFR 677C>T polymorphism, migraine, and cardiovascular disease." Neurology® 2008;71:505-513.
Press Release. "Gene May Put Women with Migraine at Increased Risk of Heart Disease and Stroke." St. Paul. American Academy of Neurology. July 30, 2008.
Women's Health Initiative. Women's Health Study. National Institutes of Health. Bethesda.
The study was supported by grants from the National Heart, Lung and Blood Institute, the National Cancer Institute, the Donald W. Reynolds Foundation, the Leducq Foundation, the Doris Duke Charitable Foundation, F. Hoffman La-Roche and Roche Molecular Systems and the German Research Foundation.
About the Women's Health Initiative (WHI): The Women's Health Initiative (WHI) was a major 15-year research program to address the most common causes of death, disability and poor quality of life in postmenopausal women -- cardiovascular disease, cancer, and osteoporosis.