Migraines with aura linked to increased cardiovascular disease risk in women

1. In this cohort of women, those who experienced migraines with aura were associated with an increased adjusted incidence rate for major cardiovascular diseases (CVD) compared to those with migraines without aura or no migraines.

2. After diabetes and smoking, migraines with aura were found to have the highest CVD incidence rate relative to other major vascular risk factors (e.g. triglyceride, HDL cholesterol, systolic blood pressure, etc.).

Evidence Rating Level: 2 (Good) 

Study Rundown: While the association between migraines with aura and incidence of CVD events has been noted in the past, the relative incidence rate compared to other established vascular risk factors had not yet been explored. In this study, researchers evaluated the relative risk for major CVD events between those who experienced migraines with aura and a reference group comprising of those who had migraines without aura or no migraines. Additionally, the incidence risk for major CVD was compared between the self-reported migraines with aura and other vascular risk factors such as elevated triglycerides or low HDL cholesterol. Findings suggest that those who reported having migraines with aura were at an increased risk for major CVD compared to those who experienced migraines without aura or did not experience migraines. Furthermore, migraines with aura were reported to have the third highest adjusted incidence rate for CVD, after diabetes and smoking. This retrospective cohort study collected data from a large sample and effectively evaluated the data using several different statistical comparison models. However, reports of experiencing migraines with aura or CVD events were dichotomous and did not provide insight on the severity or frequency at which these events had occurred. Nonetheless, these findings highlight migraines with aura as another factor to consider when assessing ones’ risk for major CVD events.

Click to read the study in JAMA 

Relevant Reading: Migraine Headache: An Under-Appreciated Risk Factor for Cardiovascular Disease in Women 

In-Depth [retrospective cohort]: Researchers evaluated data obtained from 27 858 women who were enrolled in the Women’s Health Study from 1992 to 2018. Eligible participants were female health professionals of 45 years of age or older, who did not have a history of CVD or cancer. Baseline characteristics related to cardiovascular risk factors and potential confounding variables were collected at the beginning. Participants were also asked to report whether they had experienced any migraines with aura, migraines without aura, or did not experience migraines in the year prior to the baseline assessment. Follow-ups were performed through an annual self-reported questionnaire. Those who reported cardiovascular events had their medical records further reviewed by a committee of physicians. Findings suggest that women who experienced migraines with aura had an adjusted incidence rate of major CVD of 3.36 cases per 1000 person-years (95% confidence interval [CI], 2.72-3.99) compared to 2.11 cases per 1000 person-years (95% CI, 1.98-2.24) in the reference group, those with migraines without aura or no migraines (P < .001). Compared to other risk factors, migraines with aura were reported to have a lower adjusted incidence rate than diabetes (5.76 cases per 1000 person-years [95% CI, 4.68-6.84]; P < .001) and current smoking status (4.29 cases per 1000 person-years [95% CI, 3.79-4.79]; P = .02), but a higher adjusted incidence rate than HDL cholesterol levels less than 40 mg/dL (2.63 cases per 1000-person years [95% CI, 2.33-2.94]; P = .04) and triglycerides greater than 194 mg/dL (2.67 cases per 1000 person-years [95% CI, 2.38-2.95]; P = .043).

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