Migraine, Migraine Features, and Cardiovascular Disease

Background.- Many studies support an association between migraine and cardiovascular disease (CVD). This association appears particularly in migraine with aura and is also modified by additional factors. Objective.- We sought to investigate whether the association between migraine and CVD in addition to aura status is affected by certain migraine features. Methods.- Cohort study among 27,840 women, participating in the Women's Health Study. We had detailed self-reported information on migraine and migraine features among women with active migraine (migraine during the year prior to baseline). Incident CVD events were confirmed after medical record review. We used Cox proportional hazards models to evaluate the association between migraine and incident CVD. The results have been presented in part before. We ran additional analyses according to migraine features. Results.- At baseline, 5125 (18.4%) women reported history of migraine; 39.7% of the 3610 women with active migraine indicated aura. During a mean of 11.9 years of follow-up, 708 CVD events occurred. Migraine with aura doubled the risk for CVD, ischemic stroke, and myocardial infarction. With regard to ischemic stroke, this association seemed stronger in the absence than in the presence of migraine features. This was most pronounced in the absence (hazard ratio = 3.27; 95% CI = 1.93-5.51; P < .0001) than in the presence of nausea/vomiting (hazard ratio = 0.91; 95% CI = 0.43-1.93; P = .80). In contrast, the association with myocardial infarction did not reveal a certain pattern. Conclusions.- These data suggest that the association between migraine with aura and ischemic stroke may differ by absence or presence of migraine features.