Migraines associated with an increased risk of cardiovascular events in women

1. In a review of the health outcomes of over 115 000 women as part of the Nurses’ Health Study II, women with migraines were associated with a significantly higher risk of cardiovascular disease (CVD) and mortality.

Evidence Rating Level: 2 (Good)

Study Rundown: The lifetime prevalence of migraines in the United States in approximately 20%, with women affected approximately 3 to 4 times more than men. The pathophysiology of migraines has previously been associated with vascular abnormalities, although the exact link remains unclear. The purpose of this large retrospective trial was to clarify the association between migraines and the risk of CVD.

The study analyzed the health outcomes of over 115 000 women that were originally part of the Nurses’ Health Study II. At the conclusion of the study, the presence of migraines was significantly associated with an increased risk of CVD as well as mortality from myocardial infarction, stroke, and coronary revascularization procedures. This association persists after adjustments for age, smoking status, hypertension, or oral contraceptive use. The study is one of the largest and longest studies to study the association between migraines and cardiovascular disease. However, the incidence of migraines may be skewed as migraines are self-reported by the study participants. Furthermore, there is limited information on the subtypes of migraines, including migraines with or without auras. Additional studies are warranted to investigate the potential biological mechanisms underlying this association.

Click to read the study in BMJ

Relevant Reading: Migraine, vascular risk, and cardiovascular events in women: prospective cohort study

In-Depth [prospective cohort]: The Nurses’ Health Study II (NHS) is a prospective cohort study of 116 430 registered nurses from the United States aged 25 to 42. Participants’ health information was collected through a self-administered questionnaire every two years. This study analyzed the health outcomes of the participants from its establishment in 1989 to 2011. Migraine incidence was calculated from self-reported data of whether a physician has previously provided the participant with a diagnosis of migraines. The primary outcome of this study was CVD which was assessed by the occurrence of myocardial infarctions, strokes or fatal CVD. The secondary outcome measured was cardiovascular mortality, and individual endpoints of angina/coronary revascularization procedures, myocardial infarction or stroke. Overall, 17 531 (15.2%) women reported having migraines in this cohort. During the follow-up period, 223 women died from CVD, and a total of 1329 major cardiovascular events occurred. Women with migraines were found to be at a significantly increased risk for CVD (HR: 1.50; 95% CI: 1.33 to 1.69). Specifically, women with migraines were associated with increased risk of myocardial infarction (HR: 1.39; 95% CI: 1.18 to 1.64), stroke (HR: 1.62; 95% CI: 1.37 to 1.92), and coronary revascularization procedures (HR: 1.73; 95% CI: 1.29 to 2.32). These associations remained significant after adjustments for age (greater or less than 50 years of age), smoking status, presence of hypertension, or use of oral contraceptives.

Image: CC/Wiki/ShanghaiKillerWhale

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.