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Migraine may be linked to heightened cardiovascular disease risk

It should now join the ranks of recognised risk factors, say researchers

Caroline White

Thursday, 01 February 2018

Migraine may be linked to a heightened risk of cardiovascular disease, including heart attack, stroke, blood clots and atrial fibrillation, suggests research* published in The BMJ.

Although the absolute risks were low, the findings suggest that “migraine should be considered a potent and persistent risk factor for most cardiovascular diseases in both men and women,” warn the researchers.

There are around one billion migraineurs worldwide. And while previous studies have indicated a link between migraine and stroke and heart attacks, particularly among women, the associations between migraine and other heart problems are less well known.

To explore this in more depth, the Danish and US researchers looked at the risks of heart attack; stroke; peripheral artery disease; blood clots; atrial fibrillation; and heart failure in people who experience migraines compared with those who don’t.

They drew on data submitted to the Danish National Patient Registry between 1995 and 2013.

They tracked the health of more than 51,000 people who had been diagnosed with migraine more than 510,000 people who hadn’t been.

The average age at which migraine was diagnosed was 35, and 71 per cent of the participants were women.

During the monitoring period, migraine was associated with a heightened risk of heart attack, stroke, blood clots and atrial fibrillation, but not peripheral arterial disease or heart failure.

For every 1,000 patients, 25 with migraine had a heart attack compared with 17 of those who didn’t have the condition. Similarly, 45 patients with migraine had an ischaemic stroke compared with 25 of those who didn’t have migraines.

These associations persisted even after taking account of potentially influential factors, such as weight and smoking.

The associations, particularly for stroke, were stronger in the first year of diagnosis in patients with migraine aura—warning signs before a migraine, such as seeing flashing lights—than in those without, and in women than in men.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors cannot rule out the possibility that other unknown factors, such as physical activity, may have influenced the results.

But there are possible explanations for their finding, say the researchers. People with migraine often use anti-inflammatory drugs, which are associated with increased risks of heart problems, while the immobilisation related to migraine attacks may increase the risk of blood clots.

Current guidelines don’t recommend use of anti-clotting drugs such as aspirin to treat migraine, but the researchers call on clinicians to “consider whether patients at particularly high risk of heart disease would benefit from anticoagulant treatment.”

And they go on to say: “Migraine should be considered a potent and persistent risk factor for most cardiovascular diseases.”

It’s time to take migraine seriously, say professor Tobias Kurth and colleagues in a linked editorial.**

“We now have plenty of evidence that migraine should be taken seriously as a strong cardiovascular risk marker” but “action to reduce risk is long overdue,” they argue.

“Unfortunately, funding for migraine research has been seriously neglected,” they say, calling on public research agencies to “act quickly by investing in prospective studies to accomplish this goal.”

*Adelborg K, Szépligeti SK, Holland-Bill L, et al. Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ 2018;360:k96
**Kurth T, Rohmann J, Shapiro R. Migraine and risk of cardiovascular disease BMJ 2018; 360:k275

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