Cardiovascular Disease and Migraine

Migraine Sufferers Have an Increased Risk of Cardiovascular Disease

For several years, there has been increasing evidence of an increased risk of heart disease and stroke in migraine sufferers. The risk is clearly increased in migraine with aura. Whether or not there is an increased risk in migraine without aura has been less clear. Several large studies have now been done, and we have more information about this.

In the Womens Health Initiative study, 2006, women with migraine with aura were found to have about twice the risk of cardiovascular disease as were women without migraine, or women with migraine without aura.

Also reported in 2006 was a study of men with migraine. Over 20,000 men, 1449 with migraine, were followed for 15.7 years. Information regarding aura was not available. Migraineurs in this study were younger than controls, and more likely to have high blood pressure or a cholesterol of 240 or more. They were also less likely to smoke or use alcohol.

Men with migraine in this study had a higher risk for major cardiovascular disease than men without migraine.

Cardiovascular disease (CVD) means heart disease, including heart attack (myocardial infarction), stroke, or other types of vascular problems due to arterial atherosclerosis.

Recent Studies of Migraine and Cardiovascular Disease

Reykjavik Study

The Reykjavik Study, reported in 2010, looked at a large number of people with one or more migraines a month, and followed them for 26 years. They found that both men and women with migraine with aura were at increased risk of CVD, regardless of whether or not they had classic cardiovascular risk factors (smoking, high blood pressure, high cholesterol, or diabetes.)

In this study, the excess ten-year risk of all-cause mortality at age 50 was 1.2% for men and 0.6% for women. The risk associated with migraine was less that the risk associated with hypertension, smoking, or diabetes. The study authors stated, "The absolute risk is low, and the focus should be on conventional risk factors, such as hypertension, smoking, and adverse lipid profile, for reducing the risk of cardiovascular disease, regardless of migraine status."

 GEM Study

The Genetic Epidemiology of Migraine Study, conducted in The Netherlands, looked at 863 migraine sufferers, 111 with migraine with aura only, 396 with migraine without aura only, and 81 with both migraine types. The average age was 42, and 53% were women.

This study found that the risk for cardiovascular disease over a ten year time span was < 1% in about ⅓ of all study participants. However, it was twice as high in migraine with aura and for non-migraine headaches. The risk elevation was higher for women than for men with migraine with aura.

All migraine sufferers had an increased risk of CVD compared to those with non-migraine headaches, but for migraine with aura, the risk was double compared to those with non-migraine headaches. The diagnosis of high blood pressure was more likely in all migraineurs. A maternal history of early heart attack (myocardial infarction) was associated with all migraine sufferers, while a paternal history of early MI was found in men with all migraine types.

Women who have migraine with aura were more likely to have had gestational hypertension. Female migraine with aura sufferers were also more likely to use oral contraceptives.

The authors of this study commented "Migraineurs, particularly with aura, have a higher cardiovascular risk profile than individuals without migraine." They went on to comment:
"Further research is warranted to determine why migraineurs have these risk factors more frequently than nonmigraineurs and the nature of the additional mechanism that predisposes these individuals to early-onset cardiovascular disease."

Other Studies

In a paper by Dr. Marcel Bigal, Dr. Tobias Kurth, and their colleagues, the authors have pointed out that the association of migraine with aura and cardiovascular disease could be due to several things. One possibility is that some of the migraine with aura patients were incorrectly diagnosed with TIA (transient ischemic attack) instead of migraine aura. The studies done have been large enough, however, that this is unlikely to be affecting the overall results. It is also unlikely that migraine medications are causative.

Another possibility is that one disease leads to another, and that migraine could lead to stroke or brain lesions because of repeated episodes of cortical spreading depression. We do not yet know for certain if this is the case.

It is also possible that there are shared genetic factors or shared environmental factors that account for the association between migraine with aura and cardiovascular disease. For example, migraine and heart disease risk genes could be on the same chromosome.

It has been found that migraineurs (of all types) had higher glucose levels as a group, as well as an insulin resistance pattern in 65% (as compared to 19% in the control group. Migraine sufferers were also found to have a higher rate of retinal blood vessel narrowing (retinopathy), even after controlling for age and cardiovascular risk factors.

The authors of this study noted, "Most migraine patients have migraine without aura and are at no or little increased risk of CVD. Accordingly, most patients with migraine should be reassured instead of being frightened."

Most of the same authors also participated in a more recent study involving 9107 migraine subjects and 10,000 controls. This showed an increased rate of MI (myocardial infarction) and claudication (leg pain due to arterial narrowing) in all migraine sufferers, but only found an increased rate of stroke in migraine with aura.

How does cardiovascular disease affect the body in migraine?

Why would migraine itself be a risk factor for cardiovascular disease? There are many reasons, and more than one could be a factor. We know that people with migraine have a higher rate of what are known as “prothrombotic factors,” which are things that make your blood more likely to clot. (These include things like von Willebrand factor, factor V Leiden, endothelin, and others.)

It also appears from these various studies that migraine sufferers may have an increased rate of elevated cholesterol.

Migraine researchers have noted that migraine is a complex disorder, and may not be the same biochemically or genetically in various migraine sufferers. The mechanisms behind cardiovascular disease in migraine are as yet unclear, and may themselves be complex.

What Should You Do As a Migraine Sufferer?

Most migraine sufferers will have a low risk of heart disease or stroke. The risk of cardiovascular disease due to migraine with aura is still less than the risk of cardiovascular disease associated with other risk factors, such as uncontrolled high blood pressure, diabetes, smoking, or elevated cholesterol. While some studies showed no risk in those who had migraine without aura, other studies suggested an intermediate risk for heart disease as compared to those without migraine.

The best thing to do is to control known cardiovascular risk factors. Keep your blood pressure under control. Don't smoke. If you have elevated cholesterol, work with your doctor to find the best way to control it. Keep your blood sugar well controlled if you are diabetic, and keep your weight under control to lower the risk of developing diabetes.

Future studies will likely tell us more about this connection between migraine and cardiovascular disorders—and what to do about it.

References:

1. Scher AI, Terwindt GM, Picavet HSJ, et al. Cardiovascular risk factors and migraine: the GEM population-based study. Neurology. 2005;64(4):614-620.
2. Schurks M, Rist PM, Bigal ME, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009;339(oct27 1):b3914-b3914.
3. Gudmundsson LS, Scher AI, Aspelund T, et al. Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study. BMJ. 2010;341(aug24 1):c3966-c3966.
4. Bigal ME, Kurth T, Hu H, Santanello N, Lipton RB. Migraine and cardiovascular disease. Neurology. 2009;72(21):1864 -1871.
5. Kurth T, Schurks M, Logroscino G, Gaziano JM, Buring JE. Migraine, vascular risk, and cardiovascular events in women: prospective cohort study. BMJ. 2008;337(aug07 1):a636-a636.
6. Kurth T, Gaziano JM, Cook NR, et al. Migraine and Risk of Cardiovascular Disease in Men. Arch Intern Med. 2007;167(8):795-801.
7. Kurth T, Gaziano JM, Cook NR, et al. Migraine and Risk of Cardiovascular Disease in Women. JAMA: The Journal of the American Medical Association. 2006;296(3):283 -291.
8. Bigal ME, Kurth T, Santanello N, et al. Migraine and cardiovascular disease. Neurology. 2010;74(8):628 -635.

By Christina Peterson

updated 6-19-11