Link between migraines, CVD better understood

People who experienced migraines were at higher risk for MI and peripheral arterial disease and were more likely to have CVD risk factors, regardless of the presence of aura, according to study findings.

Previously, only patients who experienced migraines with aura were thought to be at risk. “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,” the researchers wrote.

They performed a case-control study that included 102 patients with migraines and 5,243 controls. Headache diagnoses were established using a mailed questionnaire that inquired about treatment details and comorbidities. The researchers obtained patient-reported incidence of CVD events and risk factors and assessed these profiles using the validated modified Framingham risk score.

They found that patients who experienced migraine with aura had higher rates for MI, stroke and claudication. These associations remained among those who experienced migraine without aura — with the exception of higher stroke rates. Overall, migraine with aura was associated with higher rates of CV events than migraine without aura.

Patients who experienced either form of these severe headaches were more likely than controls to have diabetes (12.6% vs. 9.4%; OR=1.4; 95% CI, 1.2-1.6); hypertension (33.1% vs. 27.5%; OR=1.4; 95% CI, 1.3-1.6); and high cholesterol (32.7% vs. 25.6%; OR=1.4; 95% CI, 1.3-1.5). After adjusting for each of these CVD risk factors as well as for sex, age, disability and triptan use, the researchers found that a significant association remained between overall migraine and MI (OR=2.2; 95% CI, 1.7-2.8); stroke (OR=1.5; 95% CI, 1.2-2.1); and claudication (OR=2.69; 95% CI, 1.98-3.23).

Defining migraineurs at particularly high risk should be the subject of further study, according to the researchers, including investigations into the significance of “headache frequency and severity, frequency of auras, as well as the cumulative importance of multiple risk factors and the relative risk of migraine vs. other risk factors.”

In an accompanying editorial, Hans-Christoph Diener, MD, of the department of neurology at the University Duisburg-Essen and Judith U. Harrer, MD, of the department of neurology at Caritas Klinik St. Theresia Saarbrücken, both in Germany, emphasized that the absolute risk for vascular events among migraine patients remains small. But they encouraged those who treat patients with migraine to extend the scope of therapy beyond acute attack and migraine prevention to include CVD risk factor management, including encouraging smoking cessation and offering advice about oral contraceptive use.

Bigal M. Neurology. 2010;74:628-635.

Diener H-C. Neurology. 2010;74: 622-623.