Women With Migraine, Aura Have Increased Risk of Cardiovascular Death

Women who experience migraine with aura have an increased hazard of cardiovascular disease (CVD)—specific mortality compared with individuals with no history of headache, according to a study published in The Journal of Headache and Pain.

Migraine disproportionately affects women and may be a risk factor for CVD. In this prospective study, researchers collected data from 27,884 participants of the Women’s Health Study (WHS) to estimate the effect of nonmigraine headache and migraine, as well as migraine subtypes on all-cause and cause-specific mortality in women.

The WHS began in 1992 and was initially a randomized placebo-controlled trial created to test the effects of vitamin E and aspirin on prevention of CVD and cancer. The current study included women who provided information on migraine (past history, migraine without aura, or migraine with aura) or headache status as part of the WHS and provided a blood sample at the trial’s start.

“Links between migraine and cancer have been assessed in a few studies; these are of interest due to proposed mechanisms of hormonal involvement for both migraine and cancer, particularly for breast cancer and ovarian cancer,” researchers said.

The participants, all 45 years and older at baseline, were followed for a median of 22.7 years. Deaths due to CVD cancer, or female-specific cancers (breast, cervical, endometrial, ovarian, and uterine) were determined by physicians using medical records.

Researchers defined migraine with aura as the presence of transient neurological symptoms, often lasting 5-60 minutes before the migraine pain, which primarily affect the visual field. In addition, autopsy reports, death certificates, medical records, and information obtained from family members were used to confirm participants’ cause of death.

Of the 5128 women participating in the WHS who reported having migraine, 1435 reported experiencing migraine with aura and 2175 experienced migraine without aura. In addition, 1518 women reported a history of migraine.

After a median of 22.7 years, 5012 women had passed away. CVD accounted for 386 deaths. Researchers note there was “no association between non-migraine headache or any migraine at baseline with all-cause mortality during follow-up.” They continued, “having migraine with aura, migraine without aura, or a past history of migraine were not found to be associated with all-cause death.”

According to authors, potential mechanisms linking increased risk of CVD and migraine with aura involve endovascular dysfunctions, inflammatory processes, and genetic susceptibility.

Researchers concluded that future studies should investigate the underlying reasons for the observed increased risk of cardiovascular mortality among migraineurs with aura. These studies should also evaluate whether changes in migraine patterns across the life course may have differential effects on mortality.

Reference

Rohmann JL, Rist PM, Buring JE, et al. Migraine, headache, and mortality in women: a cohort study [published online March 17, 2020]. J Headache Pain. doi: 10.1186/s10194-020-01091-9.