September 20, 2020
Dr. Jenina S. Ignacio, MD
Migraine is a common primary headache disorder. It is an episodic headache generally associated with nausea and/or light and sound sensitivity along. It may occur with recurrent episodes of neurological, gastrointestinal, and autonomic symptoms, alone or in combination.
It affects nearly 15% of the population or about one billion people worldwide. It has a prevalence of approximately 10-20%, depending on the case, variation, age, and sex of the study population. In recent studies done, incidence of migraine has been associated to be higher in women compared to men with a 4:1 ratio respectively. Moreover, 90% of the patients have their first attack before the age of 50 years old.
Current knowledge suggests that a primary neuronal dysfunction leading to a sequence of changes intracranially and extracranially accounts for migraine. It includes the four phases namely, premonitory symptoms, aura, headache, and postdrome.
Recent studies now correlate the risks of myocardial infarction, stroke (ischaemic and haemorrhagic), peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter, and heart failure in patients with migraine. This correlation is observed more among women and among patients whose migraine occur with an aura.
A cohort study on migraine was done at the Aarhus University Hospital, Denmark by Adelbord, et al. (2017). The study included 51,032 people for migraine cohort and the matched general population cohort of about 510,320 with a median age at diagnosis of migraine at 35 y/o with 71% of the study population being women.
Results of the study showed that migraine was associated with increased risks of several cardiovascular diseases in the short term, which persisted long term. The associations were stronger in women and in patients with aura. The absolute risks for all cardiovascular outcomes, however, were low which is expected given the young age of the study population.
Notable results also included the positive predictive value in the Danish National Patient Registrywhich is high for diagnoses of myocardial infarction (97%), ischaemic stroke (97%), peripheral artery disease (91%), venous thromboembolism (88%), and atrial fibrillation or atrial flutter (95%) but is somewhat lower for haemorrhagic stroke (60-70%) and heart failure (80%).
A meta-analysis done by Sacco, et al. (2015) reported a pooled relative risk (RR) of 1.33 (95% confidence interval 1.08 to 1.64) among patients with migraine relative to those without migraine. Relative risks of myocardial infarction were comparable for men (RR=1.48, CI=0.89 to 2.45) and women (1.67, 1.36 to 2.06).
Furthermore, the Nurses’ Health Study II conducted among 115, 541 women aged 25-42 years showed that migraine was associated with myocardial infarction (hazard ratio (HR) of 1.39, 1.18 to 1.64), angina/ coronary revascularization (1.73, 1.29 to 2.32), and cardiovascular mortality (1.37, 1.29 to 2.32).
People with migraine do not struggle with more stress than headache-free individuals. It is the overreaction to changes which seems to be the issue. We cannot eliminate the stresses of everyday living but what we can do is to reduce our response to these by several techniques that includes yoga, relaxation training,electromyographic (EMG) biofeedback (for muscle tension reduction), and cognitive behavior therapy (stress management training). If these measures fail to prevent an attack, pharmacologic treatment may be deemed necessary.