The Link Between Migraines and Cardiovascular Disease
Migraines may increase your risk of heart attack, stroke, and more
Research has already established that having migraine, especially migraine with aura, increases your risk of ischaemic stroke, the most common
type of stroke. Now scientists are finding that if you have migraines, you may also be at an increased risk of developing cardiovascular disease.
What the Research Shows
Since migraine has been consistently associated with a higher risk of stroke, studies have been looking at how this risk applies to other types of cardiovascular
disease as well, such as:
- Heart attack
- Haemorrhagic stroke
- Heart arrhythmias (abnormal heart rate)
- Transient ischaemic attacks (TIAs, also known as mini-strokes)
- Angina (chest pain caused by decreased blood flow to your heart)
- Venous thromboembolism
In a 2016 study, 115,541 women were followed for more than 20 years, with 17,531 of the participants reporting a migraine diagnosis.
The study found that women with migraines had a 50 percent higher risk of developing cardiovascular disease, particularly heart attack, stroke, or angina.
Although the overall risk is still small, it's significant when looking specifically at the population of female migraineurs.
A similar 2018 Danish population study compared 51,032 people with migraine to 510,320 in the general population without, none of whom
had any previous history of cardiovascular events. The researchers found that migraine is associated with a higher risk of specific manifestations of
cardiovascular disease, including both ischaemic and haemorrhagic stroke, heart attack, and venous thromboembolism, in men and women.
These associations were even stronger in women than in men, in people who had migraine with aura than those without, and during the first year after
being diagnosed with migraine, though they persisted into the long term as well.
The researchers also found something that's new to the conversation—an association between migraine and a heart arrhythmia called atrial fibrillation.
The association of migraine with an increased long-term risk of cardiovascular disease suggests that migraine could be a significant risk factor for most
types of cardiovascular disease, particularly stroke and heart attack. This risk is higher in women, people who have migraine with aura, smokers, and
oral contraceptive users.
Theories About the Connection
Scientists are still scratching their heads about why this link exists, as the connection is likely complex. Here are some of the current theories on the
underlying mechanisms migraine and cardiovascular disease may share.
One theory is that the blood vessels of migraineurs may have some sort of vulnerability that influences both the development of migraine and
cardiovascular disease. Endothelial dysfunction, a condition in which the deepest layer of your small arteries (the endothelium) stops working properly,
is associated with both cardiovascular disease and migraine, so it's possible that it plays a part in vascular vulnerability.
Inflammation may also play a role in this connection. In fact, in one 2015 study, the combination of a statin and vitamin D (which may have anti-inflammatory effects)
were found to prevent migraines—and it's already known that statins benefit your cardiovascular risk by lowering cholesterol.
Because oestrogen is so closely associated with both migraine and cardiovascular disease, it may also explain the connection between the two conditions,
as well as why women are at higher risk.
Cardiovascular Risk Factors
Migraineurs seem to have a higher number of cardiovascular risk factors, which may play a role as well. For instance, in the aforementioned 2016 study,
compared to the women without migraines, the migraineurs were more likely to have characteristics that put someone at a higher risk of having a heart attack
or stroke, including:
- High blood pressure (hypertension)
- High cholesterol levels
- Current smokers
- A family history of heart attacks
- Obesity (body mass index, BMI, of 30 or more)
Another study, published in 2018, looked at the association between migraine and hypertension in 29,040 women who didn't have high blood pressure.
After an average follow-up time of 12.2 years later, the researchers found that, compared to women who had no history of migraine, those who had any
history of migraine had a higher risk of developing hypertension. Specifically, they found that:
- Women who had migraine with aura had a 9 percent higher risk.
- Women with migraine without aura had a 21 percent higher risk.
- Those with any past history of migraine had a 15 percent higher risk.
Since we know high blood pressure is a risk factor for cardiovascular disease, this study's findings may be another explanation for the relationship
between migraine and cardiovascular disease.
Shared genetic markers that increase the vulnerability for both migraine and cardiovascular disease are another theory behind the connection.
The big picture here is that a connection or an association doesn't mean that one causes the other. Instead, there is simply a link and potentially
one or more shared mediators.
What This Means for You
There isn't yet any evidence to confirm whether preventing migraines may lower the risk of developing cardiovascular disease. It's only known that
migraines seem to pose additional cardiovascular risk, especially for women.
This cardiovascular risk is especially a concern for women as they get older because the risk for cardiovascular disease increases as they approach
midlife and menopause. This is a result of the natural aging process and probably the decline in oestrogen that women experience as their ovaries fail
and they stop menstruating.
If you have migraines, there aren't currently any guidelines suggesting that your doctor should implement heart and stroke preventive measures, such
as aspirin therapy, based on the presence of migraines alone. There is also no scientific data supporting the use of a migraine preventive medication in
preventing another stroke in a migraineur with a history of stroke.
However, if you have migraines, it doesn't hurt to ask your doctor to check for and review with you other cardiovascular risk factors—like a history
of smoking, use of oral contraceptives, high blood pressure, high cholesterol, or a family history of heart attacks or strokes— which should be done
for everyone anyway.
A Word from Verywell
Cardiovascular disease is a leading concern, especially for women as they approach midlife, whether or not you have migraines. However, having
migraines may pose an additional risk. What is causing the link between migraines and cardiovascular disease needs to be determined by future scientific
studies. In the meantime, take steps to be good to your brain, heart, and blood vessels by maintaining a normal weight, quitting smoking, eating a healthy diet,
and exercising regularly.