Departments: Ask the Experts
This issue: the answer to a reader&#x0027;s question about how much migraine with aura raises cardiovascular risk.
Tobias Kurth, M.D., is director of research in neuroepidemiology at the Institut national de la santé et de la recherche médicale and University of Bordeaux in France and a Fellow of the American Academy of Neurology.
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Your Questions Answered
Q I am a woman who has migraine with aura. I saw that this increases my heart attack risk. How concerned should I be?
DR. TOBIAS KURTH RESPONDS:
A Many uncertainties still exist concerning the association between migraine and cardiovascular risk. In some large studies, migraine—particularly migraine with aura—has been associated with increased risk of a heart attack. The “aura” that usually precedes or accompanies a migraine can include sensory warning signs or symptoms, such as flashes of light, blind spots, or tingling in the hand or face.
At the American Academy of Neurology's Annual Meeting in San Diego last year, my colleagues and I presented findings from the Women's Health Study, which involved 27,860 women, 1,435 of whom had migraine with aura. During the 15-year study, there were 1,030 cases of heart attack, stroke, or death from a cardiovascular cause. After high blood pressure, we found that migraine with aura was the second strongest single contributor to risk of heart attacks and strokes. The data from the Women's Health Study (whs.bwh.harvard.edu) have indicated a relative risk of heart attack for women with migraine with aura that is about doubled when compared with the heart attack risk in women without migraine. However, the absolute or overall risk of a woman with migraine with aura having a heart attack remains low.
We do not understand yet whether some factor specific to migraine causes an increased risk of heart attack or whether migraine with aura is a red flag for some other risk factor.
Patients with migraine (especially with aura) should have their cardiovascular risk status assessed. This should include checking for the presence of hypertension (high blood pressure), elevated cholesterol levels, and/or diabetes.