Migraine and Vascular Disease

Migraine is a recurring headache of moderate to severe intensity that is associated with gastrointestinal, neurologic, and autonomic symptoms. As the most common of the chronic headache disorders, migraine affects 18% of women and 6% of men in the United States. More than one-half of all migraine sufferers report significant disability with the migraine. While the pathophysiology of migraine is not completely understood, there is mounting evidence that migraine sufferers are at an increased risk for cardiovascular disease and other vascular disorders, including angina, myocardial infarction, coronary revascularization, claudication, cardiovascular mortality, and ischemic lesions in the brain. There is also an increased risk of other cardiovascular risk factors, including hypertension, diabetes, and hyperlipidemia. Now, the Journal of the American Medical Association reports in a recent study that migraine is associated with pathologic changes in the cerebellum.

Migraine is a headache disorder that presents with severe, pulsating, often unilateral pain. Also, migraine can be preceded by an aura — visual or neurologic symptoms, often flashes of light, blind spots, tingling or numbness in body parts, or speech problems. Migraine occurs more frequently in women, and the prevalence is highest between 35 and 45 years of age. The newest study reported in JAMA evaluated migraine symptoms and cardiovascular risk in a cohort of nearly 5000 men and women. The participants were followed from 1967 to 2006. During midlife, participants described headache and migraine history and symptoms; nearly 30 years later, magnetic resonance imaging studies were performed to detect infarct-like lesions in the brain, without regard to clinical symptoms.

Lesions were found in 39.3% of the men and 24.6% of the women. After adjusting for confounding variables, midlife migraine with aura was significantly associated with late-life infarct-like lesions in the cerebellum of women. Migraine without aura and nonmigraine headache were not associated with increased cardiovascular risk. This corroborates the results of a recent study of nearly 30,000 middle-aged American women reported in the journal Neurology that found a significant association between cardiovascular disease and women experiencing migraine with aura. This large, prospective cohort study further reported that the association between migraine and vascular events varies with the frequency of migraine attacks. Specifically, ischemic stroke was associated with a high-migraine frequency. Still, the low number of vascular events in any of the migraine studies limits the meaningfulness of the results.

Migraine sufferers should be aware of modifiable risk factors for cardiovascular disease and engage in healthy lifestyles to decrease the risk as much as possible. However, it is also important to determine if migraine itself is a modifiable risk factor. Preventive medications are available that can avert a migraine if taken before it starts, and these may be key in preventing the appearance of vascular disorders in patients with migraine with aura. Or, migraine may be a symptom of already-present vascular disease. While the pathophysiology of migraine remains unclear, and this new association of migraine and vascular disease should not change the diagnosis or treatment of migraine or cardiovascular disease, it may help identify patients at increased risk for future vascular events, particularly middle-aged women experiencing migraine with aura.

References

Bigal, M., Kurth, T., Hu, H., Santanello, N., & Lipton, R. (2009). Migraine and cardiovascular disease: Possible mechanisms of interaction Neurology, 72 (21), 1864-1871 DOI: 10.1212/WNL.0b013e3181a71220

Kurth, T., & Schürks, M. (2009). Newest aspects on the association between migraine and cardiovascular disease: The role of modifying factors Current Pain and Headache Reports, 13 (3), 231-236 DOI: 10.1007/s11916-009-0039-4

Kurth, T., Schurks, M., Logroscino, G., & Buring, J. (2009). Migraine frequency and risk of cardiovascular disease in women Neurology DOI: 10.1212/WNL.0b013e3181ab2c20

Kurth, T., Schurks, M., Logroscino, G., Gaziano, J., & Buring, J. (2008). Migraine, vascular risk, and cardiovascular events in women: prospective cohort study BMJ, 337 (aug07 1) DOI: 10.1136/bmj.a636

Scher, A., Gudmundsson, L., Sigurdsson, S., Ghambaryan, A., Aspelund, T., Eiriksdottir, G., van Buchem, M., Gudnason, V., & Launer, L. (2009). Migraine Headache in Middle Age and Late-Life Brain Infarcts JAMA: The Journal of the American Medical Association, 301 (24), 2563-2570 DOI: 10.1001/jama.2009.932