Prevalence and Clinical Factors of Migraine in Patients With Spontaneous Coronary Artery Dissection

Abstract

Background Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome predominantly in women without usual cardiovascular risk factors. Many have a history of migraine headaches, but this association is poorly understood. This study aimed to determine migraine prevalence among SCAD patients and assess differences in clinical factors based on migraine history. Methods and Results A cohort study was conducted using the Mayo Clinic SCAD “Virtual” Multi‐Center Registry composed of patients with SCAD as confirmed on coronary angiography. Participant‐provided data and records were reviewed for migraine history, risk factors, SCAD details, therapies, and outcomes. Among 585 patients (96% women), 236 had migraine history; the lifetime and 1‐year prevalence of migraine were 40% and 26%, respectively. Migraine was more common in SCAD women than comparable literature‐reported female populations (42% versus 24%, P <0.0001; 42% versus 33%, P <0.0001). Among all SCAD patients, those with migraine history were more likely to be female (99.6% versus 94%; P =0.0002); have SCAD at a younger age (45.2±9.0 years versus 47.6±9.9 years; P =0.0027); have depression (27% versus 17%; P =0.025); have recurrent post‐SCAD chest pain at 1 month (50% versus 39%; P =0.035); and, among those assessed, have aneurysms, pseudoaneurysms, or dissections (28% versus 18%; P =0.018). There was no difference in recurrent SCAD at 5 years for those with versus without migraine (15% versus 19%; P =0.39). Conclusions Many SCAD patients have a history of migraine. SCAD patients with migraine are younger at the time of SCAD; have more aneurysms, pseudoaneurysms, and dissections among those imaged; and more often report a history of depression and post‐SCAD chest pain. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01429727, NCT01427179.

Migraine and Ischemic Stroke in Women. A Narrative Review

“…In addition to biomarkers of endothelial activation, procoagulable factors associated with migraine include thrombocytosis, polycythemia, antiphospholipid antibodies, and high estrogen states (pregnancy, CHC use) 151,152 . MWA has been associated with VTE risk in 2 prospective studies with the association ranging from 1.6 to 2.4‐fold 36,147 . In the Danish study, with a median age of 35 years, VTE was also associated with MWoA 36 .…”

“…Migraine may also be associated with spontaneous coronary artery dissection (SCAD), a rare cause of MI. A recent multicenter cohort study found that 42% of women with SCAD had migraine, almost twice the rate in historical controls 147 …”

Spontaneous coronary artery dissection in women: What is known and what is yet to be understood

“…Women with SCAD and migraine history report more chest pain, depression, anxiety, and concern for recurrent SCAD than other SCAD patients. 22 Avoidance of medications with vasoconstrictive properties, such as triptans, is generally advised. β-Blockers can be considered as a preventive strategy.…”

“…FMD, a noninflammatory, nonatherosclerotic arteriopathy, is the most common vascular abnormality . More recently, in a Mayo Clinic series of 586 SCAD patients consisting primarily of women, there was a 40% lifetime and 27% 1‐year prevalence of migraine . Those with migraines reported more anxiety, depression, chest pain, and concern for future SCAD events.…”

Association of Pregnancy With Recurrence of Spontaneous Coronary Artery Dissection Among Women With Prior Coronary Artery Dissection

“… 7 Approximately one-third of patients have a history of hypertension. 8 , 9 Most patients have abnormalities in the peripheral arteries, such as fibromuscular dysplasia (FMD), aneurysms, and dissections. 1 , 10 , 11 , 12 , 13 Only a small proportion of patients have an inherited connective tissue disease (5%-8%) 14 , 15 or family members with SCAD (1%).…”