Vascular Risk Score and Associations With Past, Current, or Future Migraine in Women

Abstract

Background and Objectives-Migraine has consistently been associated with an increased risk of cardiovascular disease (CVD) events. It remains, however, unclear to what extent cardiovascular risk profiles might be linked with migraine activity status, and how these profiles relate to the development of migraine.Methods-We used data from a cohort study of female health professionals (Women’s Health Study, n=27,539, age ≥45 years at baseline) without a history of CVD or other major diseases and who provided a blood sample at baseline. Framingham risk scores (FRS) estimating the ten-year risk of coronary heart disease calculated at baseline were used to create vascular risk categories. The presence or development of self-reported migraine was assessed by questionnaires. Women were classified as having ‘no migraine‘, ‘history of migraine’ (experienced migraine in the past but did not experience any migraine attacks in the year before enrollment), ‘migraine at baseline’ (active), or ‘incident migraine’ (first report of migraine during follow-up but not at baseline). We used multinomial logistic regression models to calculate odds ratios (ORs) for the association between FRS categories and migraine status.Results-Of the 27,539 participants, a total of 21,927 women did not report migraine, 1,500 women reported a history of migraine, 3,579 had migraine at baseline, and 533 reported migraine for the first time during follow-up. The odds of the probability of having a history of migraine at baseline (versus never migraine) was 76% higher among those with FRS ≥10% compared with FRS ≤1% after adjustment (OR=1.76, 95%CI: 1.39-2.23). In contrast, having FRS ≥10% was inversely associated with migraine at baseline (OR=0.64, 95%CI: 0.52-0.80), and with newly reported migraine during follow-up (OR=0.42, 95%CI: 0.22-0.81) when compared with women with FRS category ≤1% and those not reporting migraine. A similar inverse association pattern was observed for FRS categories 5-9% and 2-4%.Discussion-High FRS categories were only observed among women with a history of migraine but not with active migraine at baseline or incident migraine after baseline. Our results suggest that the life course of migraine should be considered when studying associations with the vascular system. Our data further suggest that a relatively healthy vascular system, as assessed by the FRS, is associated with active migraine status or developing migraine in the future.

The Challenging Puzzle of Migraine, Age, and Vascular Health

“…In summary, the study of Ibrahimi et al 3 contributes to understanding the association between migraine and vascular risk and suggests that the incidence of migraine is inversely related to vascular risk. This work also highlights the challenges of investigating the association between 2 conditions highly driven by age as a critical confounding factor that needs to be addressed in future research.…”

“…These results are consistent with those of the American Migraine Prevalence and Prevention Study, in which the proportion of women with FRS ≥21% was 0%, 0.8%, and 15.2% for age groups between 22-39, 40-59, and ≥60 years, respectively. 6 Ibrahimi et al 3 should be commended for their study. The large Women's Health Study cohort and sound regression models are strengths of this study, which adds an important contribution to the understanding of the association between vascular risk status and migraine activity.…”

“…Additional points are assigned for the presence of the other risk factors, which are more common as age increases. Notably, the study by Ibrahimi et al 3 poses a key question to guide future research, which is whether the association between vascular status and migraine activity is causal or driven by the divergent course of migraine and FRS with aging. This can be done by exploring migraine status exclusively in aged individuals, stratified by the burden of vascular risk factors or, alternatively, by the direct investigation of vascular health among these individuals.…”

“…Ibrahimi et al 3 estimated adjusted odds ratios (aORs) for the association between FRS strata and migraine status. They found that the probability of having a history of migraine at baseline vs no migraine was 76% higher among participants with FRS ≥10% compared with those with FRS ≤1% (aOR 1.76, 95% CI 1.39–2.23).…”

“…In the current issue of Neurology ®, Ibrahimi et al 3 evaluated the association between the Framingham Risk Score (FRS) and migraine status by interrogating the Women's Health Study's cohort, 4 including 27,539 healthy female health professionals aged 45 years or older at baseline. They categorized migraine status into 4 groups: (1) no migraine, (2) history of migraine (migraine in the past, but no episodes in the year before enrollment), (3) migraine at baseline (at least 1 migraine attack within 1 year before enrollment), and (4) incident migraine (no history of migraine and first reported episode during follow-up).…”