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New insights into prevalence, outcomes of spontaneous coronary artery dissection with migraine

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Marysia S. Tweet

ANAHEIM, Calif. — Migraines are common in survivors of spontaneous coronary artery dissection and are more likely to occur in women and those who are younger, according to new research presented at the American Heart Association Scientific Sessions.

Previous research has demonstrated that migraines may be more common in individuals with a history of spontaneous coronary artery dissection (SCAD) and may be linked to increased risk. Marysia S. Tweet, MD, assistant professor of medicine and senior associate consultant in the division of preventive cardiology at Mayo Clinic, Rochester, Minnesota, and colleagues performed a cohort study to assess the prevalence and outcomes of SCAD.

The study included 586 patients with angiographically confirmed SCAD who were enrolled in the Mayo Clinic SCAD Registry. Of those, 236 patients had a history of migraines.

The researchers reported a lifetime prevalence of migraine of 40% and a 1-year prevalence of 27%.

“If you compare [the prevalence data] to reported literature on migraines in young women, which is estimated about 30%, the 40% vs. 30% is statistically significant (P = .0002), but there are some limitations to that comparison, as you can imagine,” Tweet said during a presentation.

Compared with SCAD survivors who did not report migraines, those with a history of migraines were more likely to be women (99.6% vs. 94%; P = .001) and develop SCAD at a younger age (45.3 years vs. 47.5 years; P = .004).

Patients with SCAD and migraines had higher prevalence of anxiety (32% vs. 24%; P = .038), depression (27% vs. 17%; P = .005) and concern for recurrent SCAD (46% vs. 37%; P = .034).

Chest pain within 1 month of SCAD was reported by 43% of all patients in the study, with a higher rate of chest pain reported by the group with migraines (50% vs. 39%; P = .01). Chest pain occurring at any time after SCAD was reported by 51% of all patients in the study, again with a higher rate reported by the group with migraines (62% vs. 44%; P < .001), according to Tweet.

Thirty nine percent of patients with migraines stopped triptan therapy at the time of MI, according to the findings.

“Further investigation into this association [between SCAD and migraines] is necessary to develop safe, effective methods for headache, chest pain, depression and anxiety after SCAD,” Tweet said. “I think you can extrapolate some of these recommendations to any young woman who has a myocardial infarction, whether it be from SCAD or atherosclerosis. These are important considerations.” – by Darlene Dobkowski

Reference:

Tweet M, et al. Outcomes and Prevalence of Migraines in Patients with Spontaneous Coronary Artery Dissections: A Cohort Study. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, California.

Disclosure: Tweet reports no relevant financial disclosures.