Migraine and risk of cardiovascular diseases: Danish population based matched cohort study

Abstract

ObjectiveTo examine the risks of myocardial infarction, stroke (ischaemic and haemorrhagic), peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter, and heart failure in patients with migraine and in a general population comparison cohort.DesignNationwide, population based cohort study.SettingAll Danish hospitals and hospital outpatient clinics from 1995 to 2013.Participants51 032 patients with migraine and 510 320 people from the general population matched on age, sex, and calendar year.Main outcome measuresComorbidity adjusted hazard ratios of cardiovascular outcomes based on Cox regression analysis.ResultsHigher absolute risks were observed among patients with incident migraine than in the general population across most outcomes and follow-up periods. After 19 years of follow-up, the cumulative incidences per 1000 people for the migraine cohort compared with the general population were 25 v 17 for myocardial infarction, 45 v 25 for ischaemic stroke, 11 v 6 for haemorrhagic stroke, 13 v 11 for peripheral artery disease, 27 v 18 for venous thromboembolism, 47 v 34 for atrial fibrillation or atrial flutter, and 19 v 18 for heart failure. Correspondingly, migraine was positively associated with myocardial infarction (adjusted hazard ratio 1.49, 95% confidence interval 1.36 to 1.64), ischaemic stroke (2.26, 2.11 to 2.41), and haemorrhagic stroke (1.94, 1.68 to 2.23), as well as venous thromboembolism (1.59, 1.45 to 1.74) and atrial fibrillation or atrial flutter (1.25, 1.16 to 1.36). No meaningful association was found with peripheral artery disease (adjusted hazard ratio 1.12, 0.96 to 1.30) or heart failure (1.04, 0.93 to 1.16). The associations, particularly for stroke outcomes, were stronger during the short term (0-1 years) after diagnosis than the long term (up to 19 years), in patients with aura than in those without aura, and in women than in men. In a subcohort of patients, the associations persisted after additional multivariable adjustment for body mass index and smoking.ConclusionsMigraine was associated with increased risks of myocardial infarction, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter. Migraine may be an important risk factor for most cardiovascular diseases.

In a Nutshell: Findings from the Bruneck Study

“…Given the long-term follow-up of our study, lifetime prevalences were accurately estimated and emerged as high as 20% for migraine and 40% for tensiontype headache [60]. We refuted the misconception that the heightened stroke and myocardial infarction risk in migraine patients is due to an elevated burden of atherosclerosis [61] and yielded evidence that migraine facilitates venous thromboembolism as recently replicated on a large scale [62]. Further studies in the Bruneck cohort specifically targeted sleeping disorders, depression, and cognitive decline [63,64].…”

Migraine and the risk of all‐cause dementia, Alzheimer's disease, and vascular dementia: A prospective cohort study in community‐dwelling older adults

“…A relationship between vascular risk factors and migraines has also been observed . Migraines, in turn, are also a risk factor for various diseases and disorders, such as cardiovascular disease . Many of the mechanisms involved in migraine neurophysiology, such as inflammation and reduced cerebral blood flow, are also underlying causes of dementia .…”

Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine

“…As well, increases in hypothalamic–pituitary–adrenal activity may also be involved in the development of both pregnancy‐associated hypertension disorders and the risk of preterm birth . Both migraine and pregnancy‐associated hypertension disorders are associated with increased risks of cardiovascular diseases, suggesting a common etiology, possibly through genetic mechanisms …”