Researchers assess associations between migraine and markers of vascular damage

In middle-aged women, migraines with aura may confer an increased risk of carotid thickening, while migraines without aura are associated with a lower risk of carotid plaques and arterial stiffening compared with non-migraineurs, according to a recent study published in Headache.

In previous studies, researchers have linked migraine with increased risk of both coronary artery and cerebrovascular diseases. In addition, cardiovascular disease (CVD)-related mortality is high among women with migraine with aura. Little is known, however, about the pathophysiology of the relationship between CVD and migraine. Systemic vascular disease may be involved.

Therefore, researchers led by João Eudes Magalhães, MD, PhD, Division of Neurology, Hospital Universitário Oswaldo Cruz of the Universidade de Pernambuco, Recife, Brazil, conducted this cross-sectional study to assess any associations between migraine and markers of vascular damage such as carotid thickening, carotid plaques, and arterial stiffening.

“To our knowledge, this is the first study to evaluate the prevalence of the markers of vascular damage in migraineurs. We chose this approach because abnormally high values of the studied markers are more likely to be associated with increased individual risk for future CVD than the average values in a specified population,” wrote Dr. Magalhães and colleagues.

They included 277 middle-aged women (range: 45-65 years) without any known CVD, dividing them into groups based the absence or presence of migraine (n=112) and then according to migraine without or with aura (n=46). Using high-resolution B-mode carotid artery ultrasonography and the QLAB Intima-Media Thickness software, they measured carotid thickening (intima-media thickness of > 0.9 mm), carotid plaques (focal thickening over 1.5 mm or protrusions of at least 0.5 mm or 50% of the surrounding wall), and arterial stiffening (pulse wave velocity [PWV] > 10 m/s).

To calculate general cardiovascular risk in these patients, Dr. Magalhães and fellow researchers used the Framingham Heart Study algorithm, where a Framingham risk score ≥ 13 points signaled a high 10-year CVD risk. Migraine was diagnosed by a neurologist based on criteria from the third edition-beta of the International Classification of Headache Disorders.

Women who had migraine with aura had an increased risk of diffuse carotid thickening compared with women without migraine (6.8% vs 1.3%, respectively; adjusted OR: 7.12; 95% CI: 1.05-48.49). Women who had migraine without aura demonstrated a lower risk of carotid plaques compared with those without migraine (4.7% vs 16.7%; adjusted OR: 0.28; 95% CI: 0.08-0.99), as well as a lower risk of arterial stiffening (34.4% vs 51.2%; adjusted OR: 0.39, 95% CI: 0.19-0.79).

Researchers found no association between migraine characteristics and PWV measurements.

Early atherosclerotic disease and vascular aging can cause carotid thickening. The use of ultrasonography to image the carotid artery is a simple, noninvasive method widely used to quantify subclinical structural markers of vascular damage, including carotid thickening and carotid plaques. With these results, Dr. Magalhães and colleagues demonstrated its utility specifically in patients with migraine.

“Thus, evaluating [carotid intima-media thickness] CIMT appears to be a useful marker of vascular damage in migraineurs, and carotid thickening is possibly related to a migraine-specific mechanism of vascular dysfunction. Given that carotid ultrasonography is simple and easily available, it should be considered for the assessment of vascular health in migraineurs in neurological practice,” they concluded.