Dr. Kurth’s excellent prospective evaluation of healthy women who had migraine with or without aura has uncovered a huge future risk of cardiovascular or cerebrovascular disease in that segment of women who have migraine with aura. We have known from some of Dr. Kurth’s previous research that this group had a greater chance of developing heart attacks or stroke than women who have migraine without aura, but we did not know the relative impact of this condition versus other more traditional cardiovascular risk factors. Dr. Kurth, working in both Bordeaux and Boston, has found that migraine with aura has a stronger relative contribution to future cardiovascular disease than diabetes, current smoking, obesity, and family history of early heart disease. Only one other risk factor, a systolic blood pressure of 180 mm Hg or above, was a stronger risk factor for future cardiovascular disease. This 10-year follow-up of 28,000 women is one to consider carefully for practicing neurologists and headache specialists.
Clinicians should strongly consider discussing cardiovascular and cerebrovascular risk with their female patients who have migraine with aura. If they are smokers, take estrogen, or have high blood pressure or other risk factors, the discussion becomes more urgent. We have to wonder about letting them continue estrogen and we must get them to stop smoking. We might even consider which acute headache medications they can use, as medications that constrict blood vessels may make the risk worse. We need further studies to help us evaluate which preventive measures and what acute care migraine medications should be used in these patients.
—Alan M. Rapoport, MD
Clinical Professor of Neurology
The David Geffen School of Medicine at UCLA
Los Angeles, California
President-Elect
The International Headache Society (IHS)
Founder and Director-Emeritus
The New England Center for Headache
Stamford, Connecticut