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Rapaport, Alan M.D.

doi: 10.1097/01.NNN.0000286030.89401.d8
Department: Ask the Experts

Answers to your questions about neuropathy, trigeminal neuralgia, seizure meds and pregnancy, and migraine and heart disease.

Alan Rapaport, M.D., is founder and director-emeritus of the New England Center for Headache in Stamford, CT and clinical professor of neurology at the David Geffen School of Medicine at the University of California-Los Angeles.

Q Do migraines put me at higher risk of heart disease? Will getting treatment lower that risk?

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Figure. D

A If you have migraine with aura, recent data shows that you have a slightly greater lifetime risk of having a stroke or heart attack or some form of vascular disease. Symptoms of an aura may include blind spots, flashing or flickering lights, double vision, dizziness, difficulty with speech, numbness in the face, arm, or leg on one or both sides of your body, and increased sensitivity to odors.

Through epidemiological studies, which look at thousands of patients, we can see how many people in a large group have migraine with or without aura, and how many of those have cardiovascular problems. To put it in perspective, the number of people who are actually going to have a stroke or heart attack because of their migraine risk is probably quite small. It might only be four people out of 10,000. But since that is about double the normal risk, we recommend that people who have migraine with aura reduce their risk factors for vascular disease—for example, by maintaining normal blood pressure, taking care of themselves, and by not smoking or taking birth control pills. I usually tell my patients to go to a doctor on a regular basis for heart- and blood-pressure monitoring and weight control, and perhaps to take a low-dose aspirin. There's no absolute proof yet that doing this will lower the risk, but it certainly makes good sense.

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