Migraine associated with increased risk of subsequent major cardiovascular disease in men

Men with migraine headaches may be at an increased risk for major cardiovascular disease and especially heart attacks, according to a report in the April 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Migraines are recurring moderate to severe headaches that may be accompanied by visual disturbances, dizziness, nausea, vomiting or sensitivity to light and sound. More than 28 million people in the United States have this condition, which peaks in midlife, according to background information in the article. Approximately 18 percent of women and 6 percent of men have migraines.

Tobias Kurth, M.D., Sc.D., Harvard Medical School, Harvard School of Public Health and Brigham and Women's Hospital, Boston, and colleagues studied 20,084 men age 40 to 84 without a previous history of heart disease. From the time they enrolled in the study (between 1981 and 1984) through 2005, the men were sent yearly questionnaires asking about cardiovascular disease events. These included non-fatal ischemic stroke (stroke caused by reduced blood flow to the brain), non-fatal myocardial infarction (heart attack) or death from ischemic cardiovascular disease (an insufficient supply of blood to the heart). Coronary revascularization (coronary artery angioplasty or bypass surgery) and angina (chest pain) were also evaluated.

Participants were classified as having migraine if they indicated experiencing migraine during the first five years. A total of 1,449 (7.2 percent) of the men reported migraines, including 434 with frequent migraines (four or more times during the five-year period). During an average of 15.7 years of follow-up, 2,236 major ischemic cardiovascular disease events occurred, including 750 ischemic strokes, 1,046 myocardial infarctions and 866 ischemic cardiovascular disease deaths, plus 2,257 coronary revascularizations and 2,625 cases of angina.

"Compared with men who did not report migraine, those who reported migraine were at significantly increased risk of major cardiovascular disease and myocardial infarction." The incidence of major cardiovascular disease per 10,000 men per year was 8.5 for those without migraine and 10.4 for those with migraine.

"Several mechanisms have been proposed supporting a biological link between migraine and vascular events," the authors write. For instance, those with an increased body mass index (BMI) tend to have more frequent and severe migraines as well as an increased risk of heart disease, and it is possible that migraines are a marker for atherosclerosis, or a buildup of plaque in the arteries. "However, the increased risk of vascular events remained after controlling for major cardiovascular risk factors in the present data and other studies."

"In conclusion, in this large prospective cohort of apparently healthy middle-aged men, migraine was associated with increased risk of subsequent major cardiovascular disease, which was driven by increased risk of myocardial infarction," the authors write.

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