Study links migraines to several cardiovascular diseases—especially stroke

People who have migraines are more at risk than the general population for a range of adverse cardiovascular events, according to a study published in The BMJ.

Researchers studied 51,032 Danish patients with a first diagnosis of migraine and matched each one to 10 randomly sampled people with the same age and sex from the general population, creating a comparison cohort of 510,320. The median age at first diagnosis was 35 and 71 percent of the study population was women.

After adjusting for cardiovascular risk factors and following the cohort for up to 19 years, the researchers found patients with migraines had increased odds of myocardial infarction (adjusted hazard ratio: 1.49), ischemic stroke (2.26), hemorrhagic stroke (1.94), atrial fibrillation (1.25) and venous thromboembolism (1.59). There was no significant difference between the groups in the development of heart failure or peripheral artery disease.

The increased risk of cardiovascular events, especially stroke, was highest in the first year after diagnosis, reported lead author Kasper Adelborg, MD, PhD, and colleagues.

“Migraine was associated with increased risks of several cardiovascular diseases in the short term, which persisted in the long term,” wrote Adelborg, with the department of clinical epidemiology at Aarhus University Hospital, and coauthors. “The associations were stronger in patients with aura than in those without aura and in women than in men. The absolute risks for all cardiovascular outcomes, however, were low, which is expected given the young age of the study population.”

Previous studies have shown migraine to be associated with heightened risks for heart attack, ischemic stroke and hemorrhagic stroke, the authors noted. But they believe their analysis is the first to also draw a connection to atrial fibrillation (AFib) and to find no association between migraine and heart failure or peripheral artery disease. Also, the risk estimates associated with migraines were higher than in previous reports, but study design may have played a factor.

“One explanation could be our inclusion of migraine patients diagnosed in an inpatient, emergency department, or outpatient hospital setting, indicating that we may have included more patients with severe migraine than previous studies—that is, migraine necessitating treatment in a hospital setting because of higher frequency, greater pain, or longer duration,” they wrote. “In support of this inference, we observed attenuated risks when we redefined the migraine cohort to include patients receiving prescriptions for migraine treatments by community based general practitioners.”

Adelborg et al. pointed out non-steroidal anti-inflammatory drugs are often taken by migraine patients and may increase the risk of MI, venous thromboembolism or AFib. In addition, stroke and migraine may share genetic mutations that raise the risk of both conditions.

A logical next step, according to the authors, is prescribing more CVD-specific medication to migraine patients.

“Current migraine guidelines do not recommend use of aspirin and clopidogrel in the prophylaxis of migraine, but clinicians should consider whether patients at particularly high risk of cardiovascular diseases would benefit from anticoagulant treatment,” Adelborg and colleagues wrote. “Ultimately, it will be important to determine whether prevention strategies in patients with migraine can reduce the burden of cardiovascular disease in patients with this common disorder.”