The results from two large prospective studies, published in the "British Medical Journal" last year, demonstrate that those with migraine headaches, particularly with an associated aura, have an increased risk for death from cardiovascular disease and hemorrhagic stroke.
One study assessed the impact of midlife migraine episodes in over 18,000 men and women born between 1907 and 1935. These individuals were monitored for as many as 40 years. In total, the researchers assessed 470,990 person-years of data, including questionnaires to determine the nature of migraine headaches, with and without aura. There were over 10,000 deaths: approximately 4,000 from cardiovascular causes, and 6,000 from other causes.
After the researchers adjusted for the usual risk factors, it was found that individuals with migraine with aura were at increased risk for all-cause mortality and mortality from cardiovascular disease (coronary artery disease and stroke) when compared with those headache-free members of the population. In contrast, no increased risk was found for people with migraine without aura, or in people with non-migraine headache.
It is not clear whether medical or psychological interventions that serve to reduce the frequency of migraine (or aura) will lower the risk for cardiovascular disease.
A different study examined the association between migraine and migraine with aura and the risk for hemorrhagic stroke. This particular study involved almost 28,000 women, at least 45 years of age, who were free from stroke or other major disease at study entry; questionnaires were used to ask the women about migraine headaches with and without aura.
The data showed that women with active migraine with aura had more than twice the risk for hemorrhagic stroke compared with women with no history of migraine. Interestingly, women who reported active migraine without aura or migraine in the more distant past had no increased risk for hemorrhagic stroke.
Now, what to do with this information when a patient is sitting in the doctor's office is a whole other story. For many patients, these results could cause an unnecessary amount of anxiety (in a patient population that already suffers from an increased incidence of anxiety and depression), as the chance of any one individual being afflicted by these migraine-associated illnesses is really quite small. And it is still not known whether treating the migraine headache will in turn lower the risk of heart disease and stroke. Nonetheless, a "teaching moment" can be had here, reminding individuals of the importance of a healthy lifestyle, which will go a long way to lowering the risk of cardiovascular disease.
Migraine headache is thus more than a headache. It may eventually come to be regarded as a systemic illness; much research needs to be done. In the meantime, focus on the tangible. If you truly fear the cardiovascular effects of migraine with aura, stop the smoking, watch the diet, and increase the exercise. In this way, migraine with aura, in a round-about way, conveys an incentive to live the more healthful lifestyle.
No pain, no gain. So they say.