Migraine is not simply a bad headache. It’s a collection of neurological symptoms that affects the quality of life for millions of Americans. In all, about 18 percent of women and 6 percent of men in the U.S. have the condition, according to the Migraine Research Foundation.
When a migraine strikes, throbbing head pain, dizziness, and nausea can wreck social plans and prevent people from working for hours or even days. However, there can be more serious problems for some migraine sufferers. Researchers have linked migraine to an increased risk of both strokes and heart attacks.
The risk appears to be highest, especially for stroke, if you experience migraine with aura — and 20 percent of migraineurs (people who have migraines) do.
Auras consist of visual symptoms, such as flashing lights and zigzagging lines or blind spots, and typically occur about 20 minutes before a migraine headache strikes (although some people have migraine auras without head pain), according to the National Headache Foundation. Tingling and pins-and-needles sensations in one arm or leg can also be part of an aura.
Numerous studies have concluded that people who experience migraines with aura have about double the risk of suffering ischemic strokes (caused by blood clots in the brain), according to Loyola University Medical Center neurologists Michael Star, MD, and José Biller, MD, who described the association between stroke and migraine in “Headache and Migraine Biology and Management” (Academic Press).
Recent studies have also linked migraine headaches to an increased risk of hemorrhagic strokes (caused by bleeding in the brain), heart attacks, and arterial claudication (leg pain due to poor circulation) — all health problems connected with the cardiovascular system.
In hopes of identifying a genetic connection between the risk of migraine and coronary artery disease, researchers from Harvard and the Massachusetts Institute of Technology (MIT) analyzed two large studies involving almost 150,000 people that identified genetic variations linked to an increased risk of migraine and heart disease.
The goal was to find genetic variants that overlap in both diseases. What they found, however, was unexpected.
"Surprisingly, when we looked for shared gene variants that might help explain part of the link between migraine and heart disease, we found no shared gene variations between migraine with aura and heart disease," said study author Aarno Palotie, MD, of the Broad Institute of MIT and Harvard. "This is surprising because the evidence is stronger that people with migraine with aura have an increased risk of heart disease than people with migraine without aura."
The study produced another baffling result, too. Even though people with migraines who don’t experience auras have an increased risk of heart disease (although a lower risk than migraineurs with aura), they tend to have genetic variations that should protect against heart disease.
"We now need to understand why people with migraine who are born with a protective or neutral genetic risk for heart disease end up with an increased risk for heart problems,” said Anne Ducros, MD, PhD, of the University of Montpellier in Montpellier, France, who wrote an editorial accompanying the study.
The researchers concluded it’s possible still undiscovered genetic factors could play a role in the link between migraine and heart disease, but there could be another reason for the association — and it could be good news for migraine sufferers.
Lifestyle habits of people with migraines may play a significant role in the link between migraines and heart disease, and healthier habits might lessen the risk of both migraine and stroke and heart attacks. (The American Academy of Neurology offers guidelines for preventing and treating migraines with both lifestyle changes, including relaxation techniques and stress management, and medication.)
"For example, migraine has been associated with obesity, avoidance of exercise, smoking and depression, all of which increase the risk of heart disease," Ducros said.
If you are a migraine sufferer, one of the smartest moves you can make to protect your health is to stop smoking or never start. The risk of stroke is tripled for smokers and goes up seven times if you smoke and take birth control pills.
Migraine sufferers are more likely to have low levels of heart protective HDL (known as the "good cholesterol"), according to Loyola migraine experts Star and Biller. So it makes sense to work with your doctor to lower your cardiovascular risk by getting cholesterol at a healthy level with regular exercise, weight control, and medication, if needed.
September 24, 2015
Christopher Nystuen, MD, MBA