There’s some troubling news on the migraine front. As we’ve known for a while, migraines are linked to greater risk for cardiovascular problems, particularly stroke, in women who have migraine with aura, the visual or other type of sensory disturbance that is often the warning for an imminent migraine. Now we’re learning that the risk extends to many more of the one billion people worldwide with migraine, making it even more crucial that everyone with migraine be proactive about heart health.
The study: Researchers followed 51,032 Danish people with migraine and 510,320 people without the condition for 19 years. Yes, they continued to find a greater link between migraine and cardiovascular disease in women than in men…and in migraine patients with aura than in those without it. But there’s more.
They also found that women and men with migraine with or without aura are at increased risk for several cardiovascular conditions in addition to stroke—heart attack, atrial fibrillation or flutter (the upper chamber of the heart beating irregularly) and venous thromboembolism (blood clots in the deep veins of the legs or the lungs).
There was a little good news—neither women nor men with migraine had a higher-than-average incidence of heart failure (when the heart isn’t pumping blood as well as it should) or peripheral artery disease (a narrowing of the arteries in the limbs, most commonly the legs).
This study was important because of its size and because it included both sexes and looked at several specific cardiovascular diseases. But we still don’t know that migraine leads to cardiovascular disease, only that the two are somehow related. Researchers are still trying to identify why people with migraine have this higher risk. A study published in the journal PLOS ONE in 2017 found that there is at least one genetic link—an overlap of genes linked to risk for migraine and to risk for coronary artery disease, one type of cardiovascular disease. More research is needed to better understand the results of these studies and other connections between migraine and all types of heart disease.
You can’t change your genes, but you can change nongenetic factors that can increase your risk for cardiovascular disease, including smoking, being overweight, having unmanaged depression and not exercising enough. What to do: Talk to your doctor about these studies and ask for a thorough assessment of your individual risk factors for heart disease and what to do about them. Eating a healthy diet, getting daily exercise and quitting smoking are the obvious steps, but the American Migraine Foundation also suggests…
- Have your blood pressure and cholesterol checked at yearly wellness visits—high levels can be early indicators of heart disease. Work closely with your doctor if you need treatment to reduce your numbers.
- Develop a migraine prevention strategy with your health-care provider. This might include identifying your migraine triggers so that you can avoid them and taking preventive medication, such as the antimigraine drugs called triptans. But triptans aren’t for everyone. People who have coronary artery disease or risk factors for it, such as diabetes, high blood pressure or high cholesterol, should have an evaluation by a cardiologist as well as a migraine workup with a neurologist rather than their internist to determine if triptans are safe for them to take. People who have migraine with aura should also be evaluated by a neurologist rather than a family doctor. Once the specialist determines that triptans are safe for you, your family doctor can monitor your treatment.
- If you take birth control pills, discuss the benefits of progestogen-based ones over those with estrogen…they may help reduce stroke risk.