January 16, 2013
Migraine With Aura Associated With Heart Disease, Thrombosis In Women
Lawrence LeBlond for redOrbit.com - Your Universe Online
Having a headache can be a real pain. Having a migraine can often feel ten times worse. And now, women who have migraines with visual disturbances (auras), such as flashing lights, may be dealing with more than just extra pain and discomfort.
According to two new studies, to be presented in March at the 65th annual meeting of the American Academy of Neurology in San Diego, women who have migraine with aura may have a higher risk of major cardiovascular events, such as heart attack and stroke, and may also have a higher risk of dangerous blood clots if they are also using hormonal contraceptives.
In the first study, led by Tobias Kurth, MD, ScD, of the National Institutes of Health and Medical Research (INSERM) in France, researchers found that migraine with aura is a “strong relative contributor” to an increase in cardiovascular risks.
The second study, led by Shivang Joshi, MD, of Brigham and Women´s Hospital in Boston, researchers found that women with migraine–and especially those with aura–were at an elevated risk of thrombosis when also using hormonal contraceptives.
In Kurth´s study, he and his colleagues examined nearly 28,000 women, 45 and older, who were part of the Women´s Health Study and were free of cardiovascular disease at the start of the study, and for those who self-reported information on migraines. Also, women were only included who had lipid measurements available.
When the study began, 5,130 of the women reported having migraines, including 1,435 who also had aura. Over a 15-year follow-up period, the researchers found 1,030 major cardiovascular events, yielding an incidence rate (IR) of 2.4 per 1,000 women per year.
The strongest contributor to a major cardiovascular event was a systolic blood pressure of at least 180 mmHg, which translated into an IR of 9.8 per 1,000 women per year.
However, migraine with aura was a strong second, with an IR of 7.9 per 1,000 women per year.
Diabetes followed closely behind migraine with aura, at 7.1 per 1,000 women per year. Family history and current smoking tied for fourth with 5.4 per 1,000 women per year, and body mass index was right behind with 5.3 per 1,000 women per year.
While high blood pressure was the highest risk factor for a major cardiovascular event shown, Kurth noted that the evidence shows migraine with aura is nearly as dangerous for heart attack and stroke risk. And he said that people who have migraine with aura have a number of options that can lower that risk, such as not smoking, exercising more, and keeping their blood pressure in check and maintaining a healthy weight.
Kurth said that researchers do not understand the role migraine with aura plays in the contribution to cardiovascular risks, but because 20 percent of the estimated 30 million migraine sufferers in the US may experience an aura, the implications are significant.
Kurth´s research builds on a 2010 study published in the British Medical Journal that found that men and women who suffer from migraine with aura had a greater risk of dying from stroke or heart disease. And those who did not have an aura with their migraine had no increased danger.
“We have known that migraine with aura is associated with cardiovascular risk,” neurologist and migraine specialist Noah Rosen, MD, director of the Headache Center at the Cushing Neuroscience Institute, of the North Shore-LIJ Health System in Manhasset, NY, told WebMD´s Salynn Boyles. “What is striking about [Kurth´s] study is that it shows just how big this risk is.”
In Joshi´s study, researchers identified more than 145,000 women who used hormonal contraceptives such as Ortho Novum, Ortho Tri Cyclen, Yasmin and the NuvaRing, as well as others, that include estrogen and progestin. Of these women, 2,691 had migraine with aura and 3,437 had migraine without aura.
Joshi and his colleagues found that a large proportion of the women who suffer from migraine with aura and used hormonal birth control at some point had an elevated risk for blood clot complications like deep vein thrombosis (DVT) compared to those who didn´t use contraceptives.
The team found an even greater risk for deep vein thrombosis in women who used the newer combinations of hormonal contraceptives: such as drospirenone (pill), norelgestromin/ethinyl (patch) and etonogestrel/ethinyl (vaginal ring). But currently, the data is limited on how these newer combinations affect women who have migraine with aura.
Using the Partners Healthcare Registry of patient data, Joshi and his team were able to identify migraine sufferers who had been prescribed one of the newer contraceptives, or an older combination. But what they found was that there was no great difference between those who used the newer methods and those who remained on the older combinations.
The team found that 7.6 percent of women who had migraine with aura and used drospirenone were diagnosed with DVT, while women on the same combination but did not have an aura with migraine only had a 6.3 percent risk of developing the thrombotic condition. While there was no big difference in the association between DVT and method used, there was a significant difference in risk associated between those with an aura and those without.
"Women who have migraine with aura should be sure to include this information in their medical history and talk to their doctors about the possible higher risks of newer contraceptives," Joshi said.
He told Bloomberg´s Nicole Ostrow in an interview that more studies are needed to better understand the link between contraceptives and migraine with aura.
In the meantime, Joshi said women with migraines considering hormonal contraceptives should get advice from their doctor.
Rosen said both studies point to the importance of receiving an accurate migraine diagnosis.
“Only about half of people with migraines ever get diagnosed,” he told WebMD. “We now know that it is important to have a diagnosis not only for the treatment of the migraine but to understand the risk for other conditions.”
Kurth´s study was supported by the NIH.
Joshi´s study was supported by the Graham Headache Center Research Fund.