Target young women with migraine for increased cardiovascular risk prevention
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Women with migraine headaches should receive targeted atherosclerotic cardiovascular disease prevention, including attention to safer contraception and safe menopausal hormone therapy, beginning in young adulthood, according to a speaker.
Migraine headache is associated with increased cardiovascular mortality, and researchers have identified positive associations for migraine with myocardial infarction, ischemic stroke, venous thromboembolism, atrial fibrillation/atrial flutter and hemorrhagic stroke, Gina P. Lundberg, MD, clinical director of the Emory Women’s Heart Center and associate professor of medicine at Emory University School of Medicine, said during her presentation. The association with stroke is stronger for migraine with vs. without aura, and the American Heart Association and American Stroke Association guideline for prevention of stroke in women lists migraine with aura as a risk factor stroke that is more often seen in women than men.
“Migraine headache affects women four times more often than men ... most often in the reproductive years, and 50% of women report an association with menstruation,” Lundberg said. “Men with migraine headaches often report androgen deficiency as well, so there seems to be a strong hormone link.”
Oral contraceptive pills that contain estrogen may increase stroke risk with migraine, Lundberg said. Low-dose hormonal or other contraceptives that lower that risk may be preferred for women with migraine.
Lundberg also recommends transdermal estradiol and micronized progesterone or vaginal estrogen cream for high-risk women prescribed menopausal hormone therapy.
Despite few studies supporting behavioral interventions, women with migraine often report improved quality of life with smoking cessation, increased physical activity, biofeedback for stress management and avoidance of triggers, such as stress, hunger, lack of sleep and hormones, when possible, Lundberg said.
Medical therapies are the primary management tool for migraine, beginning with an NSAID. Although triptans have been prominent in treating migraine, these agents can be vasoconstrictive and should be avoided for use by women with substantial risk factors for ASCVD, Lundberg said. A newer drug classes for treating migraine, gepants, are not associated with adverse CV outcomes and may be safer for patients with high CV risk.
“The big takeaway is that women with migraine headache should be watched closely for risk of heart disease and implement healthy lifestyle strategies to reduce cardiovascular risk factors,” Lundberg told Healio.
“It is critical to identify women at higher risk for ASCVD so the proper preventive measures can be implemented and the sooner the better,” Lundberg said. “Women with migraine headaches should have attention to lifestyle, hypertension, lipids, smoking and obesity at routine wellness visits and counseling on safer birth control and menopause hormone therapy.”
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Lundberg GP. Link Between Migraine & CVD Implications for Management. Presented at: Heart in Diabetes Annual Meeting; Sept. 10-12, 2021 (hybrid meeting).
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