Migraine and severe headache affect an estimated 15% of the US population, with prevalence rates twice as high in women as in men.1 These patients often face significant disability and debilitating symptoms; common comorbidities such as insomnia and psychiatric disorders may further add to this burden. A substantial body of research demonstrates consistent associations between migraine headaches and cardiovascular disease (CVD).2
Although associations between migraine headaches and CVD have been known for more than 40 years, the underlying pathobiology of this connection has not been appreciated until recently.
A range of studies have revealed a link between migraine – especially migraine with aura – and stroke, including a case-control study showing higher rates of migraine with aura among patients with ischemic stroke vs those with no history of stroke (18.3% vs 4.4%, P =.0001).2 The increased stroke risk associated with migraine with aura was observed in women but not in male participants.
In a meta-analysis of 21 studies composed of 622,381 participants, migraine was independently associated with ischemic stroke, with a pooled adjusted odds ratio (OR) of 2.04 (95% CI, 1.72–2.43).3 An earlier investigation, which surveyed US male physicians with migraine, found a relative risk of 1.84 (95% CI, 1.06-3.20) for total stroke and 2.00 (95% CI, 1.10-3.64) for ischemic stroke compared with the physicians with no migraine history.2
In a large population-based cohort study published in 2018 in BMJ, researchers investigated the risk of various cardiovascular disorders in 51,032 patients with migraine compared with 510,320 individuals from the general population during a period of 19 years.4 Migraine was shown to be positively associated with ischemic stroke (HR, 2.26; 95% CI, 2.11-2.41), hemorrhagic stroke (HR, 1.94; 95% CI, 1.68-2.23), venous thromboembolism (HR, 1.59; 95% CI, 1.45-1.74), myocardial infarction (adjusted HR, 1.49; 95% CI, 1.36-1.64), and atrial fibrillation or atrial flutter (HR, 1.25; 95% CI, 1.16-1.36).
The association between migraine and stroke was especially pronounced in women who had been diagnosed with migraine with aura within the previous 12 months.2 Other studies further support this relationship between migraine and CVD in women, most often in those who have migraine with aura, as well as those who were younger than 45 years, smoked cigarettes, or took oral contraceptives.