Migraines with aura linked to heart disease

Women who have migraines with an aura are at a greater risk of having a heart attack than migraine sufferers who don’t get auras — visual disturbances or other symptoms that often precede a migraine.

Experts have long known that having a migraine with an aura increases the risk of stroke, and there is some evidence it may also be associated with cardiovascular disease. A new study, presented at the American Academy of Neurology's 65th Annual Meeting in San Diego this week, confirmed having migraines with auras does increase the risk of heart attack as well.

About 20 percent of migraine sufferers experience an aura.

The Women’s Health Study followed 27,860 women over 15 years. Researchers looked at the contribution of various risk factors for cardiovascular events.

"After high blood pressure, migraine with aura was the second strongest single contributor to risk of heart attacks and strokes," said study author Dr. Tobias Kurth, of INSERM, the French National Institute of Health and Medical Research, and Brigham and Women's Hospital in Boston.  "It came ahead of diabetes, current smoking, obesity, and family history of early heart disease."

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A second study, also presented at the neurology meeting, found that taking contraceptives significantly increased the risks of blood clots, or thrombotic events, for women who suffered from migraines.

The aim of the study was to see if newer versus older contraceptives increase blood clots and whether migraine with aura increased that risk further.

“My study found that women with migraines with aura and taking any combined hormonal contraceptive may be more likely to have thrombotic events than those without aura and without hormonal contraceptive use,” said the study’s lead author, Dr. Shivang Joshi, of Bringham and Women’s Faulkner Hospital in Boston.

Those migraine sufferers who experienced auras and those who took newer generation combined hormonal contraceptives had the greatest risks. Newer contraceptives included drospirenone (such as Yaz or Yasmine), the transdermal patch and the vaginal ring.

This adds to previous research, which found women who used contraceptives containing drospirenone had a higher risk of blood clots than those who use older agents.

It is not known why having an aura would increase the risk of cardiovascular events.

It's possible a “wave of electrical activity,” which may underlie migraines with an aura may predispose the brain to lesions, Joshi explained.  There may also be unknown genetic reasons for the association.

Women with migraines plus aura can reduce their risk by not smoking, keeping their blood pressure, maintaining a healthy weight and exercising.

"Women who have migraine with aura should be sure to include this information in their medical history and talk to their doctors about the possible higher risks of newer contraceptives, given their condition," Joshi said. If they do take combined hormonal contraceptives, they should be urged to quit smoking.