As if it's not bad enough having the pain of migraines, all these medical articles are coming out suggesting that people with migraines have a higher risk of heart attacks, stroke, claudication (peripheral artery disease), diabetes, hypertension, high cholesterol.
Migraines with aura were even associated with smoking.
So, how do we understand this paper: Bigal ME, et al "Migraine and cardiovascular disease: A population-based study"Neurology 2010; 74: 628-35. ?
Could migraine be an actual risk factor for these other problems?
Like always, let's look at several possibilities:
1. The association is incorrect -- this seems unlikely since multiple studies seem to show similar results, but there is always that problem of case ascertainment (how do you know who does and who doesn't have something).
2. The association is correct and there is something else that causes both the migraines and the other problems -- this is fairly likely.
3. The association is correct and migraines and cardiovascular disease/risk factors share a common genetic link (the genes contributing to them are close to each other in our DNA) -- this is also fairly likely.
4. The association is correct and migraines are caused by cardiovascular disease/risk factors -- so even though it seems that the migraines happened first, there could have been an underlying risk for the cardiovascular disease. This may be less likely since many people start having migraines very young and they don't (supposedly) have heart disease at that time, but couldn't there be something about their underlying genetic/environmental makeup that makes them destined for cardiovascular disease?
This is much more likely in the whole discussion of migraines and MS -- see:
Our analysis made WebMD and Medscape Neurology interested, see:
5. The association is correct and migraines cause cardiovascular disease/risk factors -- is it that the actual migraine disease process (inflammation on the covering of the brain [meninges]) causes cardiovascular disease? Alternatively, could it be that having migraines makes you more likely to have other (as of yet, immeasurable) habits that could predispose you to cardiovascular disease/risk factors? It would be difficult to explain the smoking association otherwise. Do we really think that migraine pathophysiology causes smoking? Couldn't it be that being a person with migraine (with aura) makes you want to smoke (maybe it relaxes you)? This is an example of how migraine can be associated with something but not cause it in the way we usually understand it.
So, we are stuck with more questions (as always), so what are our lessons?
Instead of focusing on how worried you should be about your migraines causing future health problems, you should take control over your own health and modify the cardiovascular risk factors that you can (you can't change age, sex or your family), such as smoking, blood sugar control, weight loss, cholesterol management.
The central principle of the Migraine and MS Team Approach Rule (M*STAR) is that YOU are the center of your own health team. That means you control your own destiny, but that also gives you great responsibility.
What can your doctors / neurologists learn from this?
When we see a patient with migraine, we should be sure to ask about cardiovascular risk factors and encourage you to modify them in order to maximize your potential and to work with you as a consultant for your M*STAR health team.
We need to keep this open dialogue among people with migraines and between people with migraines and their doctors. Don't forget your doctors probably have migraines too (especially neurologists and headache specialists). This is what My Grrr AYN (Migraine Association of Young Networkers) is all about.
Interestingly, establishing the association of migraine and cardiovascular disease raises the issue of our treatments and the potential for heart complications. Merck (MRK) is developing Telcagepant), a CGRP (calcitonin gene related peptide) antagonist, that we hope will be able to be used in people with migraines who have heart disease as well.
The real advance will be if treating and preventing migraines will actually reduce cardiovascular disease/risk factors.
In the meantime, remember ... an apple a day ....
Medical Director
Neurologique
info@neurologique.org
www.neurologique.org
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