Migraine and mortality: A systematic review and meta-analysis

Objective: To evaluate the evidence on the association between migraine and mortality. Methods: Systematic review and meta-analysis of studies investigating the association between any migraine (all forms of migraine collectively) or migraine subtypes (e.g. migraine with aura) and mortality published until March 2011. Results: We identified ten cohort studies. Studies differed regarding the types of mortality investigated and only four presented aura-stratified results, limiting pooled analyses with regard to migraine subtypes and with regard to cause-specific mortality. For any migraine pooled analyses do not suggest an association with all-cause mortality (five studies; pooled relative risk (RR) = 0.90, 95% confidence interval (CI) 0.71-1.16), cardiovascular disease mortality (CVD; six studies; pooled RR = 1.09, 95% CI 0.89-1.32), or coronary heart disease mortality (CHD; three studies; pooled RR = 0.95, 95% CI 0.57-1.60). Heterogeneity among studies is moderate to high. Two studies suggest that migraine with aura increases risk for CVD and CHD mortality. Conclusion: This meta-analysis does not suggest that any migraine is associated with increased risk of mortality from all causes, CVD, or CHD. However, there is heterogeneity among studies and suggestion that migraine with aura increases CVD and CHD mortality. Given the high prevalence of migraine in the general population a definitive answer to the question of whether migraine or a subtype alters risk for mortality is of high public health importance and further targeted research implicated.