Migraine Is Associated with Excess Stroke and Venous Thromboembolism Risk

Authors: Adelborg K et al. BMJ 2018 Jan 31.

In a cohort study, several other adverse cardiovascular outcomes also were more common.

Prior research has suggested an association between migraine and myocardial infarction and stroke (NEJM JW Gen Med Sep 15 2006 and JAMA 2006; 296:283; NEJM JW Gen Med Jun 1 2007 and JAMA Intern Med 2007; 167:795; NEJM JW Gen Med Oct 15 2010 and BMJ 2010; 341:3659). In this nationwide study, researchers in Denmark determined risks for adverse cardiovascular outcomes among 51,000 patients with migraine (but without known cardiovascular disease) who were compared with age- and sex-matched controls from the general population.

Median age at diagnosis of migraine was 35, and 71% of patients were women. After as long as 19 years of follow-up, migraine was associated with significantly higher relative risks for ischemic stroke (hazard ratio, 2.26), hemorrhagic stroke (HR, 1.94), venous thromboembolism (HR, 1.59), myocardial infarction (HR, 1.49), and atrial fibrillation or flutter (HR, 1.25); peripheral artery disease and heart failure occurred at similar rates in both groups. However, absolute risks for these outcomes were low: For example, cumulative incidence of myocardial infarction per 1000 people was 25 for migraine patients and 17 for the general population. The associations were stronger in patients with aura than in patients without aura and stronger in women than in men.

COMMENT

In this study, migraine was associated with excess risk for adverse cardiovascular outcomes. However, given the young age of the study population, absolute risks were low. Whether treatment that reduces migraine frequency and more aggressive cardiovascular prevention strategies in patients with migraine (e.g., lower threshold for prescribing aspirin) mitigate cardiovascular risk is unknown.