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Migraine with aura increases stroke risk in women

12/23/2009 - Articles

Migraine with aura increases stroke risk in women

By: Susan Aldridge, medical journalist, PhD

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Migraine with aura appears to be a risk factor for stroke in women, according to a new study. But the absolute risk is modified by other stroke risk factors. Migraine may cause changes in the brain that predispose to stroke.

Summary

Migraine with aura increases the risk of cardiovascular events like stroke and heart attack. A new study shows that the magnitude of this risk, in women, depends upon the presence or absence of other risk factors. The risk posed by migraine is higher for those with a low cardiovascular risk score from other factors. Further investigation is needed into how migraine with aura should be viewed when it comes to averting cardiovascular events.

Introduction

Migraine with aura affects around 7% of the United States population and it is known to increase the risk of stroke, heart attack and other vascular problems. It is not clear what the underlying mechanisms are. There are many other, better understood, cardiovascular risk factors such as high blood pressure and diabetes. What is not clear is how important migraine is as a risk factor in comparison with these more conventional factors.

What was done

Researchers at Brigham and Women's Hospital, Boston, and colleagues carried out an investigation within a large study on the effects of aspirin and vitamin E among female health professionals. The group of 27,519 women was free of cardiovascular disease at the start. They were assessed for their Framingham risk score, which is a standard way of assessing someone's cardiovascular risk, and their migraine status recorded.

What was found

Thirteen percent of the women reported active migraine at the start of the study, of whom 40 % had migraine with aura. During nearly 12 years of follow up, there were 697 cardiovascular events, including stroke and heart attack. Women who had migraine with aura were, overall, nearly twice as likely to develop cardiovascular disease.

The researchers divided women into four groups depending on their Framingham score and looked at how this affected the risk posed by migraine with aura. The link proved strongest for those with low Framingham scores and were lowest for those with higher Framingham scores. Women who had migraine without aura were not at increased risk of cardiovascular events, regardless of their Framingham score.

What this study means

Where a woman has a low risk of cardiovascular disease as measured by Framingham scores, the risk posed by migraine with aura attains more significance. It is possible that treating migraine in this group may provide significant benefit. For those who have a high risk determined by the Framingham scale, the relative risk from migraine is less significant. They should be counseled to reduce their risk from modifiable factors like overweight or high blood pressure, because migraine adds to their overall risk. Further investigation is needed - particularly into whether treating migraine reduces cardiovascular risk. Meanwhile, women who have migraine with aura need to consider their overall cardiovascular risk and see what can be done to modify it. Migraine causes changes in blood flow in the brain and releases chemicals which may cause damage to the blood vessels, thereby setting the scene for a cardiovascular event.

Source

Migraine, vascular risk, and cardiovascular events in women: prospective cohort study T. Kurth, M. Schürks, British Medical Journal, 16th August 2008, pp. 337--383

Created on: 08/29/2008
Reviewed on: 12/23/2009

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