Migraine and Cardiovascular Disease

Abstract

Migraine, especially migraine with aura is an established risk factor for ischemic lesions of the brain. Recent evidence has also linked migraine with and without aura to a broader range of ischemic vascular disorders including angina, myocardial infarction, coronary revascularization, claudication and cardiovascular mortality. The topic is therefore of considerable interest. Accordingly, herein we review the association between migraine and cardiovascular disease. We start by briefly presenting diagnostic criteria for migraine and revising its pathophysiology. We follow by summarizing the evidence on the topic. We then briefly present the results of a recent meta-analysis. We close by highlighting results of a large epidemiological study conducted after the publication of the meta-analysis. Key words: migraine, cardiovascular disease, stroke. Migrânea e doenças cardiovasculares RESUMOA migrânea, especialmente a migrânea com aura, é fator de risco para lesões cerebrais. Evidência recente sugere que migrânea com e sem aura é associada com outras doenças cardiovasculares isquêmicas, incluindo a angina, o infarto do miocárdio, revascularização coronária, claudicação e morte súbita. Iniciamos discutindo o diagnóstico da migrânea e seus mecanismos fisiopatológicos. Após sumarizar a evidência, discutimos resultados de meta-análise recente. Por fim, ressaltamos resultados de um grande estudo populacional sobre o assunto. Palavras-chave: migrânea, doença cardiovascular, acidente vascular cerebral. The association between migraine and ischemic vascular events has been studied for many years 1,2 . Original studies controversially reported an association between migraine with aura (MA) and stroke. The relationship was stronger in young women, and was magnified by the use of hormonal contraception or by tabagism 1 . Controversial topics included whether migraine without aura (MO) was also a risk factor to stroke, if the association also happened in men, and whether migraine was associated with other forms of cardiovascular disease 3 .The field has advanced considerably in recent years, with the publication of evidence that MA is indeed an established risk factor for subclinical ischemic lesions of the brain 4 , as well as for ischemic stroke, particularly among women of younger age 5,6 . The association has also been shown in men 7 . Furthermore, migraine seems also to be linked with other forms of cardiovascular disease (CVD), including myocardial infarct, angina and claudication), as well as with risk factors to CVD 8,9 . The topic has indeed gained considerable traction and robust evidence is now available. Accordingly, herein we review the association between migraine and CVD. We start by briefly presenting diagnostic criteria for migraine and revising its pathophysiology. We follow by summarizing the evidence on the topic. We then briefly present the results of a recent meta-analysis. We close by highlighting results of a large epidemiological study conducted after the publication of the meta-analysis. Migraine...

Concepts and Mechanisms of Migraine Chronification

“…For example, medications which constrict coronary arteries, such as the triptans and compounds containing ergotamine, could increase the risk of CVD in treated migraine sufferers. Since migraine with and without aura are similarly treated, this hypothesis seems unlikely 42,43 …”

Migraine and cardiovascular disease

“…For example, individuals with TIA may be erroneously classified as having aura, and TIAs, not aura, would be associated with future stroke. 25,26 Alternatively, medications used to treat migraine could increase the chance of CVD. 14,27 Nonetheless, since the association between migraine and CVD is supported by large studies conducted with different methods, 5,28 spurious interaction seems to be unlikely, although certainly not impossible.…”

Interrelationships among the MTHFR 677C>T polymorphism, migraine, and cardiovascular disease

“…Vascular dysfunctions are of particular interest since epidemiological studies have established an increased risk for ischemic vascular events among patients with migraine, in particular migraine with aura 4–6. It has been suggested that this association may be related to the 677C>T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene (rs1801133) 6, 7…”