Migraine with aura doubles the risk of stroke

Moral of the story: If you have migraine headaches with aura you should reevaluate taking oral contraceptives and smoking based on stroke risk.

Source: AMA Morning Rounds 10/28/09
HealthDay (10/27, Reinberg) reported, "Women who get migraine headaches with aura should stop smoking and using birth control pills, because they may increase their risk of stroke," according to a study appearing online Oct. 27 in the British Medical Journal. Investigators "analyzed nine studies concerning the association between migraine, with and without aura, and cardiovascular disease." The study showed that "migraine alone does not appear to alter the risk for heart attack and death from cardiovascular disease."

Source: British Medical Journal press releases
(Research: Migraine and cardiovascular disease: systematic review and meta-analysis)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3914
(Editorial: Migraine with aura and increased risk of ischaemic stroke)
http://www.bmj.com/cgi/doi/10.1136/bmj.b4380

Migraine with aura (temporary visual or sensory disturbances before or during a migraine headache) is associated with a twofold increased risk of stroke, finds a study published on bmj.com today. Further risk factors for stroke among patients with migraine are being a woman, being young, being a smoker, and using oestrogen containing contraceptives.

The risk was highest among young women with migraine with aura who smoke and use oestrogen containing contraceptives.

Migraine is a common, chronic disorder that affects up to 20% of the population. Women are affected up to four times more often than men. Up to one third of sufferers also experience an aura prior to or during a migraine headache (often described as the perception of a strange light, an unpleasant smell or confusing thoughts or experiences).

Doctors have long suspected a connection between migraine and vascular events such as stroke. So to investigate this further, an international team of researchers analysed the results of nine studies on the association between any migraine (with and without aura) and cardiovascular disease. Differences in study design and quality were taken into account to minimise bias.

They show that migraine with aura is associated with a twofold increased risk of ischemic stroke. This risk is further increased by being female, age less than 45 years, smoking, and oestrogen containing contraceptive use.

There was no association between migraine and heart attack or death due to cardiovascular disease.

In light of these findings, the authors recommend that young women who have migraine with aura should be strongly advised to stop smoking, and methods of birth control other than oestrogen containing contraceptives should be considered. They also call for additional research to investigate the association between migraine and cardiovascular disease in more detail.

The absolute risk of stroke for most migraine patients is low, so a doubling of risk is not cause for panic, explains Elizabeth Loder from Brigham and Women's Hospital, Boston, in an accompanying editorial. However, at a population level, this risk deserves attention because the prevalence of migraine is so high.

She suggests that patients who have migraine with aura should be followed closely and treated aggressively for modifiable cardiovascular risk factors.

Contacts:
Research: Kevin Myron, Manager, Media Relations, Brigham and Women's Hospital, Office of Public Affairs, Boston, MA, USA
Email: kmyron@partners.org

Editorial: Elizabeth Loder, Chief, Division of Headache and Pain, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Email: eloder@partners.org