Women with Migraines at Increased Risk of Cardiovascular Disease and Mortality

Women with Migraines at Increased Risk of Cardiovascular Disease and Mortality

The BMJ (formerly the British Medical Journal) announced that women diagnosed with migraines have an increased risk of developing cardiovascular diseases like heart attack and strokes.  A large study was published in The BMJ this week details the findings.  The following comes from The BMJ press release on the topic.

Women diagnosed with migraines have a slightly increased risk of developing cardiovascular diseases, such as heart attacks and strokes, and are somewhat more likely to die from these conditions than women who do not have migraine, according to findings of a large study published in The BMJ.

Experts say these results add to evidence that migraine should be considered an important risk marker for cardiovascular disease, adding that more research is needed to determine possible causes, and whether treatments to prevent migraines could help to reduce these risks.

Migraine has been consistently linked with an increased risk of stroke, but few studies have shown an association of migraine with cardiovascular diseases and mortality.

A team of US and German researchers carried out a large prospective study to evaluate associations between migraine, cardiovascular disease and mortality.  They analyzed data from 115,541 women enrolled in the Nurses’ Health Study II. The participants were aged 25-42 years, free from angina and cardiovascular disease, and followed from 1989-2011 for cardiovascular events, diseases and mortality.

17,531 (15.2%) women reported a physician’s diagnosis of migraine at baseline. Over 20 years of follow-up, 1,329 total cardiovascular disease events occurred and 223 women died due to cardiovascular disease.

When compared to women who did not have migraine, these results show that women who reported a migraine had a greater risk for major cardiovascular disease, including heart attacks, strokes and angina/coronary revascularization procedures.

These associations remained after adjusting for other factors that may have increased the risk for these diseases.

In addition, migraine was associated with a higher risk for cardiovascular mortality. This association was similar across subgroups of women, including by age, smoking status, hypertension, postmenopausal hormone therapy, and oral contraceptive use.

In a linked editorial, Rebecca Burch from Harvard Medical School and Melissa Rayhill from The State University of New York at Buffalo caution that “the magnitude of the risk should not be over-emphasized,” as “it is small at the level of the individual patient, but still important at a population level because migraine is so prevalent.”

While the current study controlled for a large number of vascular risk factors, no information was available for vascular biomarkers, and migraine specifics, such as migraine aura.

Nevertheless, the authors say “these results further add to the evidence that migraine should be considered an important risk marker for cardiovascular disease, at least in women,” and there is no reason why the findings can’t be applicable to men.

“Given the high prevalence of migraine in the general population, an urgent need exists to understand the biological processes involved and to provide preventive solutions for patients,” they conclude.

The editorialists Rebecca Burch and Melissa Rayhill agree “it’s time to add migraine to the list of early life medical conditions that are markers for later life cardiovascular risk.”

They say this latest study raises questions about whether treatments that decrease the frequency or severity of migraine may reduce later life vascular risks, and conclude by saying “what little evidence we do have suggests the need for therapeutic restraint [to prevent cardiovascular risk] until we have a better understanding of the mechanisms underlying the link between migraine and vascular disease.”

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Authored by: Staff

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Linda Shaw

Thanks for the very interesting article and commentary. My sister in law is a classic case of this scenario. She is 49, a chronic migraine sufferer, just had an heart attack. I would like to add 2 more points to the commentary:

1. I never underestimate the potential cardiovascular risks of NSAID use. I would not doubt that OTC treatment of headaches/migraines adds to the correlation with CV events.

2. I would urge anyone with migraines and/or heart disease, hypertension, autoimmune disease to get a proper in-lab sleep study. Sleep apnea is a silent killer- causing early and sometimes unexplained hypertension in people in their 20’s and 30’s, accelerated/early coronary artery plaques (due to apneas’ massive production of inflammatory response due to repeated drops in oxygen levels often hundreds of times per night in severe cases.

Just because you don’t snore, doesn’t mean you don’t have a specific kind of sleep apnea: obesity/hypoventilation disorder or central sleep apnea. Please get a qualified and vigilant sleep doctor to perform a good study if you are a headache sufferer, have hypertension, or heart disease/risk factors.

Thanks again!

Christine Jacobs

I’ve suffered with Migraine since I was 7 years old. They are so debilitating and now if you go to the ER for one, they have what they call a migraine cocktail. It’s Benadryl with either compazine (which makes me feel like I’m going to crawl out of my skin) or reglan (which makes my legs twitch) so they just pump me full of Benadryl. Not a very big help.

This may become a classic example of co-morbidity. That is to say, the same vascular conditions that cause heart attacks, angina, and strokes, may also make people more likely to feel migraine pain. Oddly, the complication in understanding the possible linkage between these conditions, stems from the poor level of understanding we have, of how to measure pain quantitatively. Angina pectoris presents with chest pain and respiratory distress, that also shows indications of cardiac stress on an electrocardiogram. Heart attack, even more so. Ischemic and hemorrhagic stroke also have multiple clinical indications that emergency medical technicians are trained to recognize. People treated at an ER for one of these three conditions, are very likely to have the correct diagnosis. Not so with headache pain. A headache is reported by the patient because of a pain felt in the head. It gets reported to a doctor, only when it is too severe for self-treatment with OTC pain meds, rest, and fluids. Such pain can have multiple causes, from traumatic head injury in a fall, to muscle tension in the neck or back, to glaucoma, to sinus inflammation, to migraine. Combinations of several such causes can contribute to headache symptoms, making diagnosis difficult. Moreover, human nerves can be trained to sense stimuli, that an untrained person registers as pain or discomfort, but cannot describe with any specificity. The med student who completed an anatomy class and knows her way around the otopharynx, can give the ENT doctor a guided tour during a fiberoptic endoscopy of her sinuses, as she’s going to feel the end of the endoscope as it brushes past the structures that were causing her distress…but the typical layman may be utterly clueless about where the eustachian tube outlet, the paranasal sinus cavities, or the sphenoid sinuses are even located. Since the clinician has to work with patients who are clueless about what’s behind their noses, it’s not simple to determine the extent of an inflammation of the sinuses or middle ear, just by discussion. Further complicating matters are some anatomical abnormalities. Up to four percent of patients are thought to have bone missing from their sphenoid sinuses, and a tough, flexible tissue separates the meninges from the mucosa, instead of bone. For such a patient, swelling affecting the sphenoid sinus can put pressure on the optic nerve and several other critical structures immediately adjacent, and damage to those tissues can cause cerebrospinal fluid leakage (if there’s sufficient CS fluid pressure) or infectious meningitis (if pressure inside the sinus exceeds pressure in the brain, as by blowing the nose very hard, secretions loaded with bacteria can be pushed into the CS fluid and infect the brain). Because these risks are not trivial, it would be valuable to have better systems for identifying which structure inside the head, actually hurts, when headache pain becomes severe. Thus, if we were better-able to identify and measure pain in the head, we would answer a wider range of questions, than merely picking out that… Read more »