ENS 2009: Migraine Linked to Vascular Risk Factors

Allison Gandey

July 01, 2009

July 1, 2009 (Milan, Italy) — Patients with migraine tend to have more vascular risk factors, warn specialists. Reporting here at the 19th Meeting of the European Neurological Society, experts encouraged neurologists to test patients for cardiovascular risk factors in addition to treating migraine.

"Contrary to what most of you may think, migraine patients are at increased vascular risk," said presenter Hans-Christoph Diener, MD, from the University of Essen, in Germany.

Dr. Diener pointed to evidence suggesting that women who report migraine with aura are at particular risk. "We have to avoid myocardial infarction in people with migraine with aura," he said.

Data suggest that these women are also at high risk for ischemic stroke. Dr. Diener cited 2 large-scale prospective cohort studies and 1 population-based case-control study.

Ischemic Stroke Risk

The first used data from the Women's Health Study, which included more than 39,000 apparently healthy older women. The study found a 1.7-fold increased risk for ischemic stroke for women who reported migraine with aura compared with women without migraine (relative risk, 1.71; 95% CI, 1.11 – 2.66).

The second prospective study used data from the Atherosclerosis Risk in Communities Study and included more than 12,000 older men and women. It found a 1.8-fold increased risk for ischemic stroke for people with migraine with aura compared with those without migraine (relative risk, 1.84; 95% CI, 0.89 – 3.82).

In the Stroke Prevention in Young Women Study, Dr. Diener explained that researchers matched 386 young women with first ischemic stroke with 614 age- and ethnicity-matched controls. They found that compared with women without headache, those who reported probable migraine with visual symptoms had a 1.5-fold increased risk for ischemic stroke (odds ratio, 1.5; 95% CI, 1.1 – 2.0).

When migraine with visual symptoms was taken into account with smoking and oral contraceptive use, Dr. Diener showed the risk for ischemic stroke increased 7-fold.

Oral Contraceptives and Smoking Heighten Risk

During the question period following the presentation, session moderator Jean Schoenen, MD, from the University of Liège, in Belgium, asked for more information about the risk of oral contraceptives in patients with migraine.

"If a patient has migraine with aura, takes the pill, and smokes, this is where I really get worried," Dr. Diener said. He emphasized that all patients should be encouraged to quit smoking.

Dr. Diener also warned of drug-induced migraine-related stroke. He pointed out that ergot therapy may also be linked to stroke.

"Since the introduction of triptans, such as sumatriptan, there have also been scattered reports of strokelike events," he said, "but so far none have convincingly shown a primary involvement of triptans or can exclude that the drug has been used in an event that mimics migraine."

In a similar talk on recent advances in the treatment of migraine, Cristina Tassorelli, MD, from the University of Pavia, in Italy, said that triptans are contraindicated in patients with cardiovascular diseases.

The researchers have disclosed no relevant financial relationships.

19th Meeting of the European Neurological Society: Teaching course 10. Presented June 21, 2009.

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