Migraine Linked To Stroke?

By Margarita Nahapetyan

Harvard researchers in their new finding reported the complicated link between having migraines and an increased risk of stroke and heart attacks.

Research has shown a strong connection between migraines and an increased risk of cardiovascular diseases, especially in women and particularly in those who also experience auras, or visual disturbances, such as flashing lights or geometric patterns, right before their migraine.

"Migraine with aura, in women in particular, is associated with about a doubling of the risk of stroke and heart attack," said Dr. Richard Lipton, director of the Montefiore Headache Center in New York City.

The study involved 25,000 white women who participated in the Women's Health Study. More than 4,500 women reported having migraines currently or in the past and of those, 1,275 had migraine with aura. All the participants were tested for a genetic variant called the angiotensin-converting enzyme (ACE) D/I polymorphism.

In addition, in their analysis the researchers took into consideration such factors that could affect the results, as age, body mass index, smoking habits, alcohol consumption, exercise, having diabetes or high blood pressure, family history of heart attack before the age of 60, and use of hormone replacement therapy or oral contraception.

Among the women studied, 29 per cent had two D copies of the ACE D/I polymorphism, 25 per cent had two I copies and 46 per cent had one copy of each form. During about twelve years of follow-up, 625 strokes and heart attacks have been reported.

As it turned out, the study found no association between the gene variant and migraine, migraine with or without aura, stroke or heart attacks. Also, no link has been found between the variant and cardiovascular disease and ischemic stroke, which restricts blood supply to the brain.

When the investigators further divided the women according to what combinations of the ACE D/I polymorphism they carried, they discovered that that this increase in risk was only seen in women carrying either one or two D copies of the ACE D/I polymorphism. Women who had migraine with aura and were carriers of a third genotype, called the II genotype, were not at increased risk.

"The complex relationship among this gene variant, migraine, stroke and heart disease has been the focus of many studies and the results have been controversial," says a study author Markus Schürks, MD, MSc, with the Division of Preventive Medicine at Brigham and Women's Hospital in Boston. "Getting to the bottom of whether there is a connection and why may help to develop ways to prevent issues like stroke and heart disease, which are leading causes of death in the United States."

However, Harvard researchers said that this relationship was identified with very limited information, and more studies will be needed to confirm the findings and determine if the connection is real. Meanwhile, their recommendations for women with migraines remain the same as for everybody else: risk of cardiovascular trouble can be reduced through a healthy diet, not smoking and participating in physical activity.

The study was published in the February 17, 2009, print issue of Neurology, the medical journal of the American Academy of Neurology.