By Martina M. McGrath, MD
July 6, 2016
Migraine occurs in up to 20% of the population and disproportionately affects women. Migraine with aura has previously been linked with increased risk of ischemic stroke. Proposed mechanisms include the coexistence of vascular risk factors, underlying endothelial dysfunction or increased thrombogenic potential.
In a study published in the British Medical Journal, data from a large cohort of young women (aged 25-42) enrolled in the Nurses Health Study and followed prospectively over 20 years, was analyzed to examine for association between the presence of physician–diagnosed migraine and incident cardiovascular disease. While stroke has previously been linked to migraine, few studies have examined the association between migraine and ischemic heart disease or cardiovascular death.
17,531 women had a diagnosis of migraine at baseline, increasing to 23,920 by end of the study period. In this substantial, nationally representative cohort of young women, significant associations between the presence of migraine and major cardiovascular disease, myocardial infarction, stroke, angina/revascularization and cardiovascular mortality were seen. The results are displayed in the table below.
These data further underscore the importance of considering atypical presentations and risk factors for women with cardiovascular disease, a commonly under-recognized and under-treated population. As an interesting aside, the study authors quote data from the National Health and Nutrition Examination Survey and a randomized controlled trial showing some evidence of benefit in treatment with simvastatin and Vitamin D in reducing migraine frequency. Given the high prevalence of migraine, the thought-provoking findings from this study should stimulate further investigation of mechanisms involved and opportunities for treatment to prevent the development of cardiovascular disease.
Migraine and risk of cardiovascular disease in women: prospective cohort study.
BMJ 2016;353:i2610. (Published 31 May 2016)
Dr. Martina McGrath is an Instructor in Medicine at Harvard Medical School, and a member of the Renal Division, Department of Medicine, at Brigham and Women’s Hospital, both in Boston.