Migraine increases vascular disease risk in women

BMJ-British Medical JournalJun 1 2016

By Lucy Piper

Women with migraine have a 50% increased risk of major cardiovascular disease, suggests a cohort study of Nurses' Health Study II participants.

"Our data support consideration of a history of migraine as a marker for increased risk of any cardiovascular disease event", say the researchers, led by Tobias Kurth (Charité - Universitätsmedizin, Berlin, Germany).

As well as being associated with an increased risk of major cardiovascular disease as a composite primary end point, migraine was also associated with an increased risk for each of the individual components.

The 17,531 women with migraine, aged 24 to 42 years, had a 39% increased risk of myocardial infarction, a 62% increased risk of stroke, a 73% increased risk of angina or needing coronary revascularisation and a 37% increased risk of death due to cardiovascular disease, compared with the 98,010 women without.

The researchers report that this increased risk persisted after taking into account traditional vascular risk factors such as older age, smoking, hypertension, hypercholesterolaemia and higher body mass index, which were more prevalent among women with than without migraine.

A total of 1329 major cardiovascular events occurred in the women with migraine over 20 years of follow-up and 223 women died from cardiovascular disease.

"Given the high prevalence of migraine in the general population, an urgent need exists to understand the biological processes involved and to provide preventive solutions for patients", say Kurth and colleagues in The BMJ.

Indeed, they cite the finding of a previous randomised trial showing initial evidence of reduced migraine burden with a combination of statin and vitamin D, which may be due to anti-inflammatory effects and call for further targeted research.

But in a related editorial, Rebecca Burch (Harvard Medical School, Boston, USA) and Melissa Rayhill (The State University of New York at Buffalo, USA) urge caution over assuming statins and aspirin will have beneficial effects particularly when migraine is the sole risk factor.

"[W]hat little evidence we do have suggests the need for therapeutic restraint until we have a better understanding of the mechanisms underlying the link between migraine and vascular diseases", they write.

Nevertheless, the editorialists agree that "it is time to add migraine to the list of early life medical conditions that are markers for later life cardiovascular risk", but warn against overestimating the magnitude of risk.

"It is small at the level of the individual patient but still important at a population level because migraine is so prevalent", they explain.

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