Migraine and Cardiovascular Disease Risks - Dangerous?

Patient Expert

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Findings of a study published in Neurology®, the Journal of the American Academy of Neurology add to previous findings that Migraine disease is tied to increased risk of cardiovascular disease.

The Study

Study objective:

"Although the relationship between migraine and cardiovascular disease (CVD) has been studied, several questions remain unanswered. Herein we contrast the rate of diagnosed CVD as well as of risk factors for CVD in individuals with migraine with and without aura (MWA and MWOA) and in controls."1

Study methods:

  • Participants were drawn from the American Migraine Prevalence and Prevention (AMPP).*
  • Study included 6,102 Migrainuers and a control group of 5,243 participants without Migraine.
  • Migraine diagnosis was assigned using a validated questionnaire mailed to participants.
  • Questionnaire also also obtained details on treatment, comorbidities, and other variables.
  • CVD events were self-reported.
  • As part of the American Migraine Prevalence and Prevention (AMPP) study, 120,000 U.S. households representative of the U.S. population have been followed for 5 years. Accordingly, we took advantage of the accurate characterization of headaches in the AMPP cohort, and resurveyed participants using the same well-validated CVD instruments from the Women's Health Study,7 in order to 1) profile cardiovascular risk factors for CVD in migraineurs and controls; 2) ascertain cardiovascular events in individuals with migraine vs controls; and 3) assess the relationship of MWA and MWOA and CVD in both men and women across a broad range of ages."1

Study results:

  • Migraine overall and MWA were associated with myocardial infarction (heart attack), stroke, and claudication (pain in the calf, thigh or hip muscle that occurs after walking)

  • MWOA was associated with myocardial infarction and claudication.

  • Participants with Migraine were more likely than control participants to have:

    • diabetes (12.6% vs. 9.4%)
    • hypertension (33.1% vs. 27.5%)
    • high cholesterol (32.7% vs. 25.6%)
    • Risk was higher in MWA, but remained elevated in MWOA
  • Migraine was significantly associated with:

    • myocardial infarction: occurred in 4.1% of Migraine group, 1.9% of control group
    • strokes: occurred in 2.1% of Migraine group, 1.2% of the control group
    • claudication: occurred in 2.9% of Migraine group, 2.57% of control group

Study conclusions:

"Both migraine with and without aura are associated with cardiovascular disease (CVD) and with risk factors for CVD. However, since our sample size is large, the clinical relevance of the differences is yet to be established."1

The authors write:

"Both MWA and MWOA are associated with CVD and with risk factors for CVD. Providers should be aware of this association in order to properly identify individuals at particularly high risk, as well as in order to plan treatment that targets not only migraine, but the complications potentially associated with migraine."1

Related editorial:

In a related editorial, Diener and Harrer ask the question, "Is there a direct link between migraine and cardiovascular disease (CVD) risk factors, or is there a shared pathogenesis, or a shared genetic basis for both?"2

They also list three conclusions that can be drawn from the study:

  1. The absolute risk of cardiovascular events in Migraineurs is still small, so patients should be given actual numbers rather than figures of relative risk increases.
  2. The perception that Migraineurs have a healthier lifestyle is incorrect. They base this on the higher incidence of diabetes, hypertension, and high cholesterol.
  3. Migraineurs, particularly those who have MWA, should be evaluated for CVD risk factors and taught how to reduce modifiable risk factors.

Diener and Harrer state:

"As neurologists, we must sharpen our diagnostic view when we see migraine patients by asking about and checking for vascular risk factors, and improve our treatment plans by advising not only about treatment of acute attacks and migraine prevention, but also about risk factor management."2

Summary and comments:

There are some differences between this study and previous studies showing Migraineurs to have increased risk of cardiovascular disease:

  • This study also included data on the increased prevalence of diabetes, hypertension, and claudication among Migraineurs.
  • This study showed a higher risk of heart attack and claudication among those with Migraine with aura.

Diener and Harrer make the same point that I've made in other articles about Migraine and CVD - The increased risk percentages aren't where we should be concentrating because most of us don't know how many incidents the percentages translate to. It's far better to grasp what our risk truly is when we look at actual numbers rather than percentages.

The best way to take care of ourselves and not be overly frightened of the prospect of cardiovascular disease is to sit down with our doctors and discuss these issues. Here are some questions for our doctors:

  • How many people in my age group have cardiovascular disease? (Age makes a difference, so it's wise to ask about our own age group.)
  • What risk factors do I have for cardiovascular disease?
  • Which of those risk factors can I modify?
  • How do I modify them?

The information from studies showing a correlation between Migraine and cardiovascular disease aren't reason to panic. They are, however, very good reason to have a serious conversation with our doctors. If you haven't had this discussion with your doctor, consider making an appointment for that discussion. There are many risk factors that we CAN reduce.

Related articles:


Resources:

1 M.E. Bigal, MD, PhD; T. Kurth, MD, PhD; N. Santanello, MD; D. Buse, PhD; W. Golden, MSci; M. Robbins, MD; R.B. Lipton, MD. "Migraine and cardiovascular disease." Neurology® 2010;74:628-635.

2 Hans-Christoph Diener, MD; Judith U. Harrer, MD. "Is migraine a dangerous disease?" Neurology® 2010;74:622-623.

3 Norton, Amy. "Migraines tied to risks of heart attack, stroke." Reuters Health. New York. February 10, 2010.

Medical review by John Claude Krusz, PhD, MD

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