Migraine in women is linked to increased risk of CVD and death

Migraine is associated with an increased risk of cardiovascular diseases in women, including coronary events and cardiovascular mortality, according to a study published May 31, 2016, 2016 in The BMJ.

Given the results of this study, migraine should be considered an important risk marker for cardiovascular disease in women, the researchers concluded.

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

For this research, investigators in the U.S. and Germany analyzed data from 115,541 women (ages 25-42 at baseline) enrolled in the large, prospective Nurses’ Health Study II. The participants were free from angina and cardiovascular disease, and followed from 1989 to 2011 for cardiovascular events, diseases, and mortality. Overall, 17,531 (15.2%) women reported a diagnosis of migraine at the start of the Nurses’ Health Study.  

During 20 years of follow-up, 1,329 total cardiovascular disease events occurred and 223 women died due to cardiovascular disease. After adjusting for confounding factors, the researchers determined that migraine was associated with a 50% increased risk for major cardiovascular disease, a 39% increased risk for heart attack, a 62% greater risk for stroke, and a 73% greater risk for angina/coronary revascularization procedures, when compared to women without migraine.

In addition, women with migraine had a 37% greater risk for cardiovascular disease mortality.

These associations were similar across subgroups of women, including by age, smoking status, hypertension, postmenopausal hormone therapy, and oral contraceptive use, the researchers noted.

“The study findings have several implications. Firstly, it is time to add migraine to the list of early life medical conditions that are markers for later life cardiovascular risk,” according to an accompanying editorial written by Rebecca C. Burch, Instructor in Neurology at Harvard Medical School in Boston, MA, and Melissa L. Rayhill, Assistant Professor of Neurology at SUNY’s Jacobs School of Medicine and Biomedical Sciences in Buffalo, NY.

However, they added, the magnitude of the risk should not be blown out of proportion. “It is small at the level of the individual patient but still important at a population level because migraine is so prevalent,” they wrote. “Furthermore, at least in the United States, prevalence of migraine is especially high in certain minorities and lower socioeconomic groups, who commonly have more cardiovascular risk factors.”

The study also raises the question of what treatment, if any, might be appropriate. “Do treatments that decrease the frequency or severity of aura or headache reduce later life vascular risks? Should patients with migraine be treated with statins or aspirin?” wrote Dr. Burch and Dr. Rayhill.

“We should be cautious about assuming that these interventions will benefit people with migraine, despite their intuitive appeal. An exploratory subgroup analysis from the Women’s Health Study, for example, showed that women with migraine with aura who took aspirin actually had an increased risk of myocardial infarction,” they noted in their editorial. “Thus, what little evidence we do have suggests the need for therapeutic restraint until we have a better understanding of the mechanisms underlying the link between migraine and vascular disease.”