Migraine

Summary

Conventional cardiovascular risk factors account for a significant proportion of cardiovascular diseases. The identification of novel and unconventional risk factors may provide strong advances in cardiovascular disease prevention, especially in young patients where these risk factors are less common. Robust evidence exists to support that migraine may be considered an emerging cardiovascular risk factor. Patients who experience migraine compared with non-migraineurs have an increased risk of developing ischaemic stroke. The evidence of such association is more pronounced for migraine with aura than for migraine without aura, and the risk of stroke is higher in young migrainous women but is also present in older women and in men. Moreover, women who experience migraine with aura compared with non-migrainous women have an increased risk of myocardial infarction, coronary revascularization, angina and death due to ischaemic cardiovascular disease. Men who experience migraine also have an increased risk of cardiovascular disease compared with non-migrainous men; however, in this case, the increase is driven mainly by myocardial infarction and not by ischaemic stroke. The mechanisms underlying the association between migraine and cardiovascular disease have not yet been clarified and several possibilities exist. The most probable hypothesis is that, at the basis of this association between migraine and cardiovascular disease, there is an endothelial dysfunction that may be responsible for both migraine and cardiovascular disease; despite there being several other hypotheses for this association, this particular hypothesis should not be overlooked. In the presence of other associated vascular risk factors, the risk of cardiovascular disease is further increased in migraineurs. For patients who experience migraine with aura, we recommend heightened vigilance and active control of cardiovascular risk factors. Further studies should investigate whether different preventive medications for migraine attacks might modify the cardiovascular risk in those who experience migraine.

Cardiology and Clinical Practice 2010; 2 (1): 53-65 (ISSN: 2036-5802).