Migraine Comorbidities: Cardiovascular Disorders And The Migraine Connection PART 1

Cardiovascular Disorders: PART 1

The connection between migraine and heart health (cardiovascular disorders) has been established for many decades. For example, we know that people who experience migraine with aura are about twice as likely to have an ischemic stroke,[1] and many people with migraine experience palpitations (fast-beating or fluttering heart) and other cardiovascular symptoms, especially during migraine attacks. To complicate matters, some types of migraine (e.g. hemiplegic) have similar symptoms to a stroke, such as disorientation, vision changes, vertigo, and speech changes.

While previous research suggested a connection between migraine and stroke, more recent research has also found an association between migraine and a host of other cardiovascular disorders. These disorders include, but are not limited to:

• Angina (pained caused by decreased blood flow to the heart)
• Atrial fibrillation
• Heart attack
• Hemorrhagic stroke (when a blood vessel ruptures in the brain)
• Hypertension
• Mitral valve prolapse
• Patent foramen ovale
• Venous thromboembolism (when a blood clot forms in the deep veins of the leg, groin or arm, and travels in the circulation, lodging in the lungs)

Understanding the Connections

One study, which followed 115,541 women for more than 20 years, found those with migraine (17,531) had a 50% higher risk of developing cardiovascular disease including heart attack, stroke, or angina. Though the overall risk is still considered small, it’s significant for women, who suffer from migraine more often than men. (See part 2 of this blog for more information about women, migraine and cardiovascular disease).[2]

Another recent study compared people with migraine to the general population without migraine. The results suggested that migraine is linked to a higher risk of the disorders mentioned above. In addition, researchers found a new association between migraine and atrial fibrillation, which is a heart arrhythmia.[3]

Patent Foramen Ovale (PFO)

Yet another link is between people with migraine and a congenital heart defect called patent foramen ovale (PFO). The foramen ovale is a flap in the atrial septum (the wall between the upper chambers of the heart). In about 25% of births, the hole does not close on its own. While the link is unknown, it is believed to be related to platelets, the tiny blood cells instrumental in forming blood clots. These clots may reach the brain and trigger migraine attacks. As many as 40-50% of people with migraine with aura also have PFO, which is twice the rate of patients without migraine or with migraine without aura.[4]

High Blood Pressure

A study of almost 30,000 participants found that after more than 12 years, those with migraine had a higher rate of developing high blood pressure. People with migraine with aura had a 9% higher risk. People with migraine without aura had a 21% higher risk. And people with any history of migraine had a 15% higher risk. This study provided a lot of insight into the connection between migraine and cardiovascular disease, and raised the idea of one affecting the other.[6]

Theories around the reasons for the connection between migraine and cardiovascular conditions include the following, but there is a lot of research still needed:

• Vascular vulnerability: Structural vulnerability in the blood vessels can influence both the development of migraine and cardiovascular difficulties.
• Inflammation: A recent study found that combining a statin for cholesterol control paired with vitamin D, which has anti-inflammatory properties, can prevent migraine as well as benefiting cardiovascular health.[7]
• Genetics: Another theory is that people with both migraine and cardiovascular disease share genetic markers for both conditions.[8]
• Estrogen: Linked to both migraine and cardiovascular conditions, a drop in estrogen levels may explain why women are at higher risk for both.

Let Us Know: Do you have migraine and heart disease and if so, have it impacted your migraine treatment options? What are your tips for staying healthy? Do you have advice for people dealing with these conditions?

Sources:

1. https://www.stroke.org.uk/what-is-stroke/are-you-at-risk-of-stroke/migraines-and-stroke#:~:text=Occasionally%20migraine%20and%20stroke%20can,symptoms%2C%20but%20is%20extremely%20rare
2. https://www.bmj.com/content/353/bmj.i2610
3. https://www.bmj.com/content/360/bmj.k96
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7736411/#:~:text=PFO%20seems%20to%20play%20a,PFO%20and%20non%2DPFO%20groups
5. https://www.bmj.com/content/353/bmj.i2610
6. https://journals.sagepub.com/doi/10.1177/0333102418756865
7. https://onlinelibrary.wiley.com/doi/10.1002/ana.24534
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690985/