Severe migraines could signal elevated risk for AFib, stroke

A decades-long study of patients who have migraines with visual aura has linked the painful headaches to an increased risk of experiencing atrial fibrillation and, to a lesser degree, stroke, researchers report in the online edition of Neurology.

Roughly one in seven Americans will be afflicted by migraines each year, but the Atherosclerosis Risk in Communities trial, led by Souvik Sen, MD, MS, MPH, of the University of South Carolina in Columbia, focused on a smaller subset of the migraine community: those who experience visual aura, or disturbances in their vision before traditional head pain sets in.

Sen and his colleagues said visual aura can present as flashes of light, blind spots, wavy lines or blurred vision. In the past, the symptom has been suggested as an indicator for ischemic stroke.

“Since atrial fibrillation is a common source of strokes caused by blood clots, and previous research has shown a link between migraine with aura and stroke, we wanted to see if people who have migraine with aura also have a higher rate of atrial fibrillation,” Sen said in a release from the American Academy of Neurology. “Atrial fibrillation can be managed through medication, but many people do not realize that they have [it].”

Sen’s team initially screened nearly 12,000 adults with no history of AFib or stroke for headache symptoms, eventually identifying 9,405 individuals without headache and 1,516 with a history of migraine. Of those who had migraines, 426 reported migraine with visual aura.

During 20 years of follow-up, 18 percent of patients with migraine with aura, 14 percent of patients with migraine without aura and 17 percent of patients without any headaches developed atrial fibrillation. After adjusting for age, sex, blood pressure and other factors, those with migraine with aura were 30 percent and 40 percent more likely to develop AFib than their counterparts with no headaches or migraine without aura, respectively.

“Our research suggests that atrial fibrillation may play a role in stroke in those with migraine with visual aura,” Sen said. “It is important to note that people with migraine with aura may be at a higher risk of atrial fibrillation due to problems with the autonomic nervous system, which helps control the heart and blood vessels.”

Sen et al. estimated nine in 1,000 people with migraine with aura will develop atrial fibrillation. The rate of stroke in that group was four in 1,000 people, while the rate of stroke in patients with migraine without aura was two in 1,000.

Sen said his team’s study was limited in that it used a narrow definition of migraine and didn’t account wholly for any migraine medications patients might have been taking.

“More research is needed to determine if people with migraine with visual aura should be screened for atrial fibrillation,” he said.