Migraine with aura is a risk factor both for cardiovascular mortality and for all-cause mortality, according to a study in the August 24 online BMJ.
Larus S. Gudmundsson, a doctoral student at the University of Iceland in Reykjavik, and colleagues investigated headache and mortality among a cohort of 18,725 adults from the area of Reykjavik. These participants, born between 1907 and 1935, took part in a 1967-1991 study of heart disease that included questionnaires and clinical measures and had a mean follow-up of 26 years. After grouping the cohort into a migraine with aura group, a migraine without aura group, a nonmigraine headache group, and a nonheadache group, the researchers looked at the outcomes of cardiovascular mortality, noncardiovascular mortality, and all-cause mortality.
Among the migraine with aura group, the hazard ratios for cardiovascular mortality and all-cause mortality were 1.27 and 1.21, respectively, compared with the nonheadache group. Furthermore, the migraine with aura group’s hazard ratios for coronary heart disease and stroke were 1.28 and 1.40, respectively, compared with the nonheadache group. Neither the migraine without aura group nor the nonmigraine headache group showed an increased risk for cardiovascular mortality or all-cause mortality compared with the nonheadache group.
Men showed a marginally higher risk for cardiovascular disease than women in the migraine with aura group. With regard to overall mortality, the researchers found that “at age 50, men and women with migraine with aura had a median loss of 1.5 and 1.4 years of life, respectively, compared with those without headache.” Women with migraine with aura also showed an increased risk for noncardiovascular mortality.
Possible mechanisms for a link between migraine and cardiovascular disease include a genetic component, ischemic events caused directly by migraine, and “the hypothesis that migraine might be a systemic disorder that is affecting vasculature,” the researchers wrote.
Future studies should “determine if reducing the frequency of attacks with migraine preventive treatment might reduce the risk of cardiovascular disease,” they suggested.
The researchers noted, however, that migraine with aura appears to be a weaker risk factor for cardiovascular and all-cause mortality than such established risk factors as smoking, diabetes, and high blood pressure. The “focus should be on conventional risk factors … for reducing the risk of cardiovascular disease, regardless of migraine status,” they wrote.