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Studies Reveal Migraine With Aura
is Risk Factor for Heart Disease |
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BY MAURY BREECHER
Contributing Writer |
SCOTTSDALE, ARIZ. (ECCC)—
Epidemiological studies have revealed that headache is a
progressive disease, chronic daily headache is very common,
migraine is both a syndrome and a disease, and that migraine
with aura is associated with coronary heart disease (CHD) and
stroke, reported Dr. Richard Lipton on February 18 during his
presentation at a Headache Research Summit presented by the
Diamond Headache Clinic Research and Educational Foundation.
“Chronic daily headache is a very common disorder afflicting
four to five percent of the general population,” said Dr. Lipton
of the Albert Einstein College of Medicine, New York. “The more
attacks a person has, the more he or she can expect to have in
the future.”
According to Dr. Lipton, data from the Frequent Headache
Epidemiology (FrHE) study confirms that headache is a
progressive disease (Scher Al et al. Pain. 2003;16:81-89).
Knowledge that it is progressive is important because
understanding the risk factors for progression may help in the
development of disease modifying treatments, he said.
Dr. Lipton pointed out that that a large case-controlled,
cross-sectional study identified that the risk factors for
progression to Chronic Daily Headache (CDH) include attack
frequency, medication overuse, low education/socioeconomic
status, stress life events, and snoring.
The FrHE data reveals that migraine is a higher risk factor for
CHD than general headache, reported Dr. Lipton. The incidence of
CDH is 3/100 person-years in population studies of headache
studies and the incidence of CHD is 14/100 person-years in
clinic-based studies of migraine.
Migraine, particularly migraine with aura, is associated with an
increased risk of ischemic stroke based on both case control and
cohort studies. Furthermore, the risk of stroke is increased by
smoking and the use of exogenous estrogens, said Dr. Lipton.
Although tension-type headache is more common in the general
population, in doctors’ waiting rooms migraine is the
predominant disorder.
“Women are more susceptible than men to migraines, up to 18
percent of all women and 6 percent of men have had migraine at
some time in their life,” said Dr. Lipton.
Migraine is often associated with many other disorders that
bring patients to the waiting room, including anxiety, asthma,
depression, and irritable bowel syndrome, he continued. Migraine
is also co-morbid with neurologic problems such as epilepsy and
ischemic stroke and other disorders such as coronary artery
disease and GI disturbances.
“In women, migraine is most common between the ages of 25 and
55, the peak productive years,” Dr. Lipton said.
Although migraine with aura is an important risk factor for
heart disease, the attributable risk of major CHD risk factors,
such as smoking and hypertension, is much higher than the
attributable risk for migraine with aura. Still, migraineurs
with aura should be encouraged to modify risk factors, Dr.
Lipton emphasized.
Although certain risk factors are not readily modifiable, others
can be, such as obesity, medication overuse, stressful life
events, snoring, and sleep apnea, he said.
As part of the Women’s Health Study of nearly 40,000 female
health professionals, a prospective cohort of more than 27,000
initially healthy women were followed for more than 15 years.
After controlling for cardiovascular risk factors, migraine with
aura was associated with increased risk of total coronary heart
disease (CHD), myocardial infarction, coronary
revascularization, and angina. However, migraine without aura
was not associated with any of the evaluated CHD outcomes, said
Dr. Lipton. He said the association of migraine with aura
appears to be the result of shared environmental and CHD risk
factors as well as shared genetic susceptibility.
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