Migraines Linked to Fatal Cardiovascular Disease

Aug. 25, 2010— -- People who suffer from migraine headaches face heightened long-term risks of cardiovascular disease and death, according to two large studies.

In one study, people who got migraine headaches with aura -- visual disturbances that accompany the painful headaches in nearly a third of all migraine sufferers -- were at a 27 percent higher risk for cardiovascular mortality compared with people who did not get migraines, Larus Gudmundsson, of the University of Iceland in Reykjavik, and colleagues reported online in BMJ.

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Migraine sufferers were 22 percent more likely to die from coronary heart disease and 30 percent more likely to die from stroke compared to people without migraines, the researchers reported.

Gudmundsson and colleagues analyzed data from the Reykjavik Study, which was a population-based study of cardiovascular disease established in 1967. The study included 18,725 men and women born between 1907 and 1935 whose average age at study entry was 52.8.

Overall, 11 percent of people experienced migraines and eight percent also had aura. Women were affected more commonly, with 15 percent having migraines compared to only six percent of men.

In the second study, also published online in BMJ, Dr. Tobias Kurth, of Harvard University in Boston and UPMC University in Paris, and colleagues found that women with active migrainse and aura had more than double the risk for hemorrhagic stroke compared to those without migraines.

A potential explanation for these findings, according to Gudmundsson and colleagues, is that migraine headaches might represent a systemic disorder of the vasculature, with heightened vascular reactivity even in early adulthood.

"Migraine with aura is an independent risk factor for cardiovascular and all cause mortality in men and women but weaker than major established risk factors, such as cigarette smoking, diabetes, and high blood pressure," the researchers wrote.

Therefore, to reduce the risk of cardiovascular disease, the focus should remain primarily on conventional risk factors such as hypertension and cholesterol, they concluded.

The study by Kurth and colleagues analyzed data from the Women's Health Study, which included 27,860 healthy women 45 years of age and older.

Nearly a fifth of participants reported a history of migraines, 70 percent of those within the past year. Among those with active migraine, 1,435 (40 percent) also reported having auras with the headaches.

Women with migraines were 2.78 times more likely to suffer intracerebral hemorrhagic stroke and 3.56 times more likely to suffer fatal hemorrhagic stroke compared to women without migraines, Kurth and colleagues found.

In an editorial that accompanied the studies, Dr. Klaus Berger, of the University of Muenster in Germany, and Dr. Stefan Evers, of University Hospital Muenster, pointed out difficulties arising from these findings.

An important concern, they wrote, is whether clinicians should inform patients with migraines about their potential risk for future vascular disorders, noting that this could create undue anxiety in some patients.

"Future research will have to assess whether prophylactic drug treatment of migraine not only reduces the number and severity of migraine attacks but also reduces subsequent cardiovascular and cerebrovascular events. However, because this will require long follow-up, in the meantime clinicians must carefully weigh the decision whether or not to discuss the risks related to this condition," they wrote.

Limitations of the study by Gudmundsson and colleagues included the fact that only people with at least one headache a month were included, and the investigators were unable to adjust for potential changes in risk factors over time.

Kurth and colleagues noted that the number of cases of hemorrhagic stroke was small, and although their findings were statistically significant, they should be interpreted with caution.