Migraine with visual aura is a risk factor for incident atrial fibrillation

Abstract

ObjectiveMigraine with visual aura is associated with cardioembolic stroke risk. The aim of this study was to test association between migraine with visual aura and atrial fibrillation (AF), in the Atherosclerosis Risk in Communities study.MethodsIn the Atherosclerosis Risk in Communities study, a longitudinal, community-based cohort study, participants were interviewed for migraine history in 1993–1995 and were followed for incident AF through 2013. AF was adjudicated using ECGs, discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Mediation analysis was conducted to test whether AF was a mediator of migraine with visual aura-associated stroke risk.ResultsOf 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraines with visual aura, 1,090 migraine without visual aura, 1,018 nonmigraine headache, and 9,405 no headache. Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1,516 with migraine and 1,623 (17%) of 9,405 without headache. After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache (hazard ratio 1.30, 95% confidence interval 1.03–1.62) as well as when compared to migraine without visual aura (hazard ratio 1.39, 95% confidence interval 1.05–1.83). The data suggest that AF may be a potential mediator of migraine with visual aura–stroke risk.ConclusionsMigraine with aura was associated with increased risk of incident AF. This may potentially lead to ischemic strokes.

Migraine and Ischemic Stroke in Women. A Narrative Review

“…In the ARIC study, migraine with visual aura was associated with cardioembolic stroke (HR 1.7; 95% CI: 1.2‐2.6, P = .008), but not with thrombotic or lacunar subtypes, suggesting visual aura symptoms may be related to distal emboli in the posterior circulation 154 . The study also reported that MWA was associated with increased risk of new onset atrial fibrillation, an important stroke risk factor in the aged 155 . These findings, combined with the discovery that late‐life ischemic stroke was associated with late (rather than early) onset MWA, 156 implies that aura may be secondary to atrial fibrillation‐associated microembolism.…”

Effect of genetic liability to migraine on coronary artery disease and atrial fibrillation: a Mendelian randomization study

“…Observational studies have identified migraine as an independent risk factor for coronary artery disease (CAD) and atrial fibrillation (AF) . However, identifying causal relationships in observational settings can be challenging due to residual confounding, misclassification or reverse causality .…”

Migraine with Aura as a Stroke Mimic

“…4 The increased incidence of atrial fibrillation and cardioembolism in patients diagnosed with migraine with aura was linked to acute stroke. 5,6 Migraine with aura can also be found as a stroke mimic during acute stroke management 7 ; however, only a few studies investigated the frequency and characteristics of migraine with aura in patients who initially presented with strokelike symptoms.…”

“…4 Recent studies showed that migraine with aurainduced stroke may be associated with an increased risk of incidental atrial fibrillation and cardioembolic stroke. 5,6 Because we included patients diagnosed with migraine with aura who initially presented with stroke-like symptoms, all patients underwent ECG and multimodal CT scan, and more than half patients underwent DWI MRI. We found no patients with perfusion change or asymptomatic ischemic stroke.…”