People with migraine headaches report more angina, but not more heart disease

People with a history of migraines and other headaches lasting at least four hours are more likely to report suffering from the chest pain doctors call angina than people who do not experience such headaches, a new University of North Carolina at Chapel Hill study concludes. That is especially true for those who also experience "aura" around the time of their headaches -- seeing what appear to be spots or lines before their eyes.

The study, led by Dr. Kathryn M. Rose, research assistant professor of epidemiology at the UNC School of Public Health, showed, however, that migraines and such were not associated with coronary heart disease.

"Our findings suggest that the higher prevalence of chest pain, but not coronary disease, among those with migraines or other severe headaches may be related to something other than heart disease," Rose said. "For example, people with migraines might have greater sensitivity to pain or be more prone to vasospasms.

"What our work does not say is that people with headaches should ignore chest pain since that is an important symptom of a number of conditions, including coronary disease," she said.

A report on the research appears in the Dec. 28 issue of the journal Neurology. Besides Rose, authors are doctoral student April P. Carson of UNC; Catherine P. Sanford of the N.C. Department of Health and Human Services; Dr. Paul Stang of Galt Associates Inc.; Dr. C. Andrew Brown of the University of Mississippi Medical Center; and Drs. Aaron R. Folsom and Moyses Szklo of the University of Minnesota and of the Johns Hopkins University schools of public health, respectively.

The study involved analyzing health data from 12,409 black and white men and women, who participated in the Atherosclerosis Risk in Communities Study. That research is a long-term, multicenter investigation of factors associated with hardening of the arteries in four U.S. communities and how the illness progresses.

Patients who underwent physical examinations and completed detailed interviews lived in Forsyth County, N.C., the northwest suburbs of Minneapolis, Washington County, Md., and Jackson, Miss. Among questions asked were whether subjects periodically suffered headaches lasting four hours or more.

Overall, women were more likely than men to suffer migraine headaches, Rose said. Whites got them more often than blacks did.

After adjusting for factors such as age, race, hypertension, smoking and total cholesterol, participants with a history of migraine or other headches with aura were three times more likely to report a history of exertional chest pain than those without a historyof headaches. No significant association was seen between headaches and verified coronary heart disease.

The World Health Organization’s Rose angina questionnaire, which the scientists employed, is widely used in epidemiologic studies as a standard way to screen for the condition, the UNC scientist said. It is not a diagnostic test.

"Generally, a person is classified with ‘Rose’ angina based on how they respond to a series of questions about chest pain in response to exertion," she said.

Not all exertional chest pain meets the criteria of Rose angina, however. Studies report that those with Rose angina are more likely to be diagnosed with coronary heart disease later. But the association is far from perfect, and in studies to date, it is a better predictor in men than in women.

"Our assessment of aura was limited to visual aura, which is the most common and includes patient reports of seeing spots, jagged lines or heat waves in one or both eyes," Rose said.

Not all people with migraines experience auras and in the new study, the prevalence of migraine with aura was much lower than the prevalence of migraine without aura, she said.

"Auras tend to precede when migraine headache start, and so for some people they are a warning that the headaches will soon happen," Rose said.

Drs. Giancarlo Logroscino of the Harvard University School of Public Health and Richard B. Lipton of the Albert Einstein College of Medicine wrote an accompanying editorial.

"The relationship between headaches in general and migraine in particular with the risk of coronary heart disease has been debated for many years," they wrote. "In this issue of Neurology, Rose et al. offer an important new chapter in this evolving story."

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