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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 72, Number 21, May 26, 2009 Italian Translation Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bigal, M. E. Articles by Lipton, R. B. Search for Related Content PubMed PubMed Citation Articles by Bigal, M. E. Articles by Lipton, R. B. Related Collections Migraine

Migraine and cardiovascular disease

Possible mechanisms of interaction

From the Departments of Neurology (M.E.B., R.B.L.) and Epidemiology and Population Health (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Scientific Affairs (M.E.B.) and Outcomes Research (H.H.), Merck Research Laboratories, Whitehouse Station, NJ; Division of Preventive Medicine (T.K.), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Epidemiology (N.S.), Merck Research Laboratories, Upper Gwynedd, PA; and The Montefiore Headache Center (R.B.L.), Bronx, NY.

Address correspondence and reprint requests to Dr. Marcelo E. Bigal, One Merck Drive, P.O. Box 100, WHS3C-26, Whitehouse Station, NJ 08889-100 marcelo_bigal{at}merck.com

Migraine, especially migraine with aura (MA), is an established risk factor for ischemic lesions of the brain. Recent evidence has also linked migraine to a broader range of ischemic vascular disorders including angina, myocardial infarction, coronary revascularization, claudication, and cardiovascular mortality. The mechanisms which link migraine to ischemic vascular disease remain uncertain and are likely to be complex. Cortical spreading depression, the presumed substrate of aura, may directly predispose to brain lesions and that would explain why MA is consistently demonstrated as a risk factor for cerebral ischemia, while for migraine without aura (MO), the evidence is less consistent. Additionally, individuals with migraine have a higher prevalence of risk factors known to be associated with cardiovascular disease (CVD), including hypertension, diabetes, and hyperlipidemia. The increased prevalence of CVD risk factors is also higher for MA than for MO. Since the evidence linking migraine and CVD is getting robust, neurologists should be aware of this association. Individuals with MO seem to be at little increased risk of CVD. MA is associated with an increased risk of ischemic stroke and likely also for other ischemic CVD events. Accordingly, heightened vigilance is recommended for modifiable cardiovascular risk factors in migraineurs, especially with MA. Ultimately, it will be important to determine whether MA is a modifiable risk factor for CVD and if preventive medications for migraine or antiplatelet therapy might reduce the risk of CVD in patients with MA.

Abbreviations: BMI = body mass index; CDH = chronic daily headache; CI = confidence interval; CSD = cortical spreading depression; CVD = cardiovascular disease; EPC = endothelial progenitor cells; HR = hazard ratio; MA = migraine with aura; MMP = matrix metalloproteinase; MO = migraine without aura; MTHFR = methyltetrahydrofolate reductase; RR = relative risk.

Disclosure: Author disclosures are provided at the end of the article.

Received November 19, 2008. Accepted in final form February 20, 2009.

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