Migraines With Aura Signal 'Moderate' Heart Attack, Stroke Risk
Painful migraine headaches are a warning that more dangerous pain may lie ahead.
A new study shows in men what earlier studies showed in women: People who get migraines are at higher risk of heart attack and stroke than are people who don't get migraines.
For women, the risk is confined to those who get migraines with aura, a before-headache phenomenon in which a person may see flashes of light or smell odd odors. That's probably true for men, too, says study researcher Tobias Kurth, MD, ScD, assistant professor of medicine at Harvard Medical School, although the men's study was unable to address this issue.
"It looks like it is only migraine with aura that is causing the potential problem. And that is the minority of migraine sufferers," Kurth tells WebMD. "Even among those with aura, the absolute risk for an individual, it is a moderate to small risk."
Migraine isn't as big a heart disease risk factor as high cholesterol, high blood pressure, or obesity -- but it is a risk. The Kurth study compared men with identical heart disease risk factors. Those with migraines were 42% more likely to have heart attacks.
"In terms of prediction, we can identify migraine as a predictor of cardiovascular disease," Kurth says.
The problem isn't the drugs migraine sufferers use. Migraine sufferers take the same medications, in the same doses, whether or not they have auras. Yet the risk seems to be confined to those who experience migraine with aura.
Moreover, the most common and effective migraine drugs -- those in the triptan family -- can't be used by people at high risk of heart disease. The heart risk is linked to migraines, not migraine treatment, Kurth says.
The findings appear in the April 23 issue of Archives of Internal Medicine.
Migraine Headache, Cardiac Heartache?
Why would a headache cause a heart attack? Nobody knows. But there are several possibilities, suggests Richard B. Lipton, MD, professor of neurology, epidemiology, and social medicine at Albert Einstein College of Medicine, Bronx, N.Y.
"One possibility is that having migraine attacks causes atherosclerosis," Lipton tells WebMD.
What makes this plausible is that heart disease is linked to inflammation, an immune process that causes blood vessels and other tissues to set off emergency alarms throughout the body. Migraine attacks trigger inflammatory responses.
Another possibility is that the same genetic factors that underlie heart disease also underlie migraine with aura. Migraines usually appear in young adulthood, while heart disease usually appears much later. So migraines, rather than causing heart disease, could simply be an early warning sign of trouble ahead.
Lipton says there is a bright side to having migraines with aura.
"Knowing that migraine is a risk factor creates an opportunity to change your more serious risk factors and to reduce your risk," he says. "Stop smoking, control your blood sugar, don't be obese, lower your cholesterol, and lower your blood pressure. If people see their migraines as a signal to take better care of themselves, this finding will have public health benefit."
Daniel J. DeNoon - WebMD
