Migraine and cardiovascular disease: a population-based study.
OBJECTIVE
Although the relationship between migraine and cardiovascular disease (CVD) has been studied, several questions remain unanswered. Herein we contrast the rate of diagnosed CVD as well as of risk factors for CVD in individuals with migraine with and without aura (MA and MO) and in controls.


METHODS
In this case-control study, migraineurs (n = 6,102) and controls (n = 5,243) were representative of the adult US population. Headache diagnosis was formally assigned using a validated mailed questionnaire which also obtained details on treatment, comorbidities, and other variables. CVD events were obtained based on self-reported medical diagnosis. Risk factors for CVD and modified Framingham scores were computed.


RESULTS
In unadjusted analyses, migraine overall and MA were associated with myocardial infarction, stroke, and claudication, and MO was associated with myocardial infarction and claudication. Migraineurs were more likely than controls to have a medical diagnosis of diabetes (12.6% vs 9.4%, odds ratio [OR] 1.4, 95% confidence interval [CI] 1.2-1.6), hypertension (33.1% vs 27.5%, OR 1.4, 95% CI 1.3-1.6), and high cholesterol (32.7% vs 25.6%, OR 1.4, 95% CI 1.3-1.5). Risk was highest in MA, but remained elevated in MO. Framingham scores were significantly higher in MO and MA than in controls. After adjustments (gender, age, disability, treatment, CVD risk factors), migraine remained significantly associated with myocardial infarction (OR 2.2, 95% CI 1.7-2.8), stroke (OR 1.5, 95% CI 1.2-2.1), and claudication (OR 2.69, 95% CI 1.98-3.23).


CONCLUSIONS
Both migraine with and without aura are associated with cardiovascular disease (CVD) and with risk factors for CVD. However, since our sample size is large, the clinical relevance of the differences is yet to be established.
1 Merck Dr., PO Box 100, Whitehouse Station, NJ 08889-0100, USA. marcelo_bigal@merck.com
M E
ME
Bigal
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T
Kurth
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N
Santanello
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D
Buse
W
W
Golden
M
M
Robbins
R B
RB
Lipton
D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D020326:Migraine without Aura / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology; D016017:Odds Ratio; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000453:epidemiology; D011795:Surveys and Questionnaires