Migraine Pattern Linked to Heart Attack Risk

By Robert Shmerling, M.D.
Content provided by the Faculty of the Harvard Medical School

Women with a certain pattern of migraine headaches may be more likely to have a heart attack, a study has found. The study included about 28,000 women, age 45 or older. More than 3,500 women had migraines. Some had migraines with aura. They would see flashing lights or have blurred vision before a headache. During the 12-year study, 1 out of 100 women had a heart attack. Heart attack rates were twice the average in women who had a migraine with aura less than once a month. No increased risk was seen with women who had migraines more often or without aura. An earlier study in this group found four times the average risk of stroke among women who had migraines with aura once a week. The new study appeared in the journal Neurology. HealthDay News wrote about it June 24.

What Is the Doctor's Reaction?

For people with migraine headaches, it's bad enough to have to put up with the pain. But a new study suggests something even more worrisome: You may be at higher risk for stroke and heart attack.

The study's findings applied only to "migraine with aura." This type used to be known as "classic migraine." In this condition, other symptoms come before the headache. The "aura" can include flashing lights or blurred vision. Migraine is common. It affects an estimated 1 out of 5 people. But only 1 out of 5 migraines have an aura.

The research findings come from an analysis of nearly 28,000 female health professionals. All were at least age 45. None had a stroke or heart attack before the study began. During the next 12 years, about 1% of the study subjects suffered heart attacks. Just over 1% had strokes.

The researchers found that some women with migraines had different rates of heart attack and stroke than women who did not have migraines. Some problems were more common with frequent migraines. Other problems were more common with infrequent migraines.

For example, those with a history of migraine with aura:

  • Had an increased risk of cardiovascular events if the migraines occurred less than monthly. Women with more frequent headaches had no increased risk.

  • Had a risk of stroke that was four times higher if the migraines occurred at least weekly

  • Had about twice as many heart attacks (or procedures to prevent them) if migraines occurred less than monthly

  • Had no clear increased risk of heart disease if migraines occurred more than monthly

The idea that migraines, heart attacks and stroke might be linked is not entirely new. Prior research has raised the same concern. Many doctors already tell patients with migraines (especially those with aura) to avoid birth control pills. The pill is linked to a small increased risk of stroke. Migraines also may increase stroke risk.

Still, the size and design of this new study mean that its findings carry more weight than prior studies.

What Changes Can I Make Now?

I don't think the results of this new research are cause for alarm. In fact, it's hard to know whether the results are reliable.

For one thing, the number of heart attacks and strokes was low. That makes estimates of disease risk subject to error. In addition, people reported what type of migraine they had and how often they occurred. If the researchers had required a doctor to confirm this, the results might have been different. We also don't know if the findings apply to men, younger women or people with the more common type of migraine (without aura). So, it's probably too early to change doctors' advice based on this one study.

Still, it's particularly important for women who have migraine with aura to do the routine things that can lower the risk of stroke and heart attack. For example:

  • Don't smoke.

  • Exercise regularly.

  • Follow a "heart healthy" diet.

  • Control blood pressure, blood sugar and cholesterol levels. Eat a healthful diet, lose excess weight and get regular exercise. If necessary, your doctor can prescribe medicines to help.

  • Maintain a healthy weight. Obesity increases the risk of diabetes, high blood pressure and high cholesterol. These in turn greatly increase the risk of heart attack and stroke.

  • Take low-dose aspirin if you have a history of heart disease, stroke or factors that increase your risk. But be sure to check with your doctor before starting aspirin. It may cause side effects, such as stomach ulcers.

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Did You Know?

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The most common type of headache in children is migraine.