Medical Perspectives | Others

February 24, 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.

References:

  1. Kasper Adelborg, SzimonettaKomjáthinéSzépligeti, et al. Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ 2018;360:k96 http://dx.doi.org/10.1136/bmj....
  2. Kurth T, Winter AC, Eliassen AH, et al. Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ 2016;353:i2610. doi:10.1136/bmj.i2610
  3. Sacco S, Ornello R, Ripa P, et al. Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies. Eur J Neurol2015;22:1001-11. doi:10.1111/ene.12701
  4. Bigal ME, Lipton RB, Stewart WF. The epidemiology and impact of migraine. CurrNeurolNeurosci Rep 2004;4:98-104. doi:10.1007/ s11910-004-0022-8
  5. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33:629-808. doi:10.1177/0333102413485658
  6. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2163-96. doi:10.1016/S0140- 6736(12)61729-2
  7. Lipton RB, Bigal ME. The epidemiology of migraine. Am JMed 2005;118(Suppl 1):3S-10S. 5 Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache 2015;55:21-34. doi:10.1111/head.12482
  8. John Wiley & Sons, Inc. Headache. The Journal of Head and Face Pain 2014 American Headache Society
  9. Harrison's Principles of Internal Medicine (19th edition.). (Chapter 447,Migraine and Other Primary Headached Disorders).
  10. www.uptodate.com

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