Migraine With Aura Contributes to Cardiovascular Events and Blood Clots

Women who have migraine with aura, especially those who take combined hormonal contraceptives (CHCs) have an increased risk for cardiovascular or thrombotic events, according to 2 different studies that will be presented in March at the upcoming American Academy of Neurology’s 65th Annual Meeting in San Diego.^1,2
   
In the first study, data from 27,860 women aged 45 years and older who had participated in the Women’s Health Study were evaluated to determine the relative contribution of migraine with aura to cardiovascular disease.¹ At baseline, 5130 women reported migraine, with 1435 (40%) of these women reporting migraine with aura. During a 15-year follow-up, there were 1030 confirmed major cardiovascular events, including nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular disease death. After adjustment for systolic hypertension (180 mm Hg or higher), which had an adjusted incidence rate (IR) of 9.8 per 1000 women per year, migraine with aura was the second strongest single contributor to risk factors for major cardiovascular events, with an adjusted IR of 7.9, according to the study authors. Other contributors to major cardiovascular events were diabetes (IR, 7.1), a family history of premature MI (IR, 5.4), current smoking (IR, 5.4), and body mass index of 35 kg/m2 or greater (IR, 5.3).
   
In the second study, researchers identified 145,304 women from a patient data registry who had used previously selected CHCs and then evaluated the risk of thrombotic events in women with migraine with aura (n=2691) and without aura (n=3437) who used newer versus older CHCs.² The. A subanalysis by migraine type showed that more patients who had migraine with aura experienced thrombotic complications than patients who had migraine without aura. Of the women with migraine who used drosperinone-ethinyl estradiol, a newer CHC, deep vein thrombosis was diagnosed in 7.6% of those who had migraine with aura and 6.3% of those who had migraine without aura. Overall, among all women who had migraine and who used any CHC, those with aura had higher rates of thrombotic complications than those without aura. In addition, when rates of thrombotic complications were compared between users of CHCs with migraine and users of CHCs without migraine, women with migraine were more at risk.
   
Together, these studies show that migraine with aura is an important risk factor for cardiovascular and thrombotic events in all women, especially for women who use CHCs. The use of CHCs in women with aura remains controversial.

Pertinent Points:
- Migraine with aura is second only to systolic hypertension as a single contributor risk factor for cardiovascular events in women.
- Women with migraine who used combined hormonal contraceptives (CHCs) had higher rates of thrombotic events than women without migraine who used CHCs.
- Of the women with migraine, those with aura had higher rates of thrombotic events than those without aura.

 

References:

1. Kurth T, Bubes V, Buring J. Relative contribution of migraine with aura to cardiovascular disease occurrence in women. In: Program and abstracts of the American Academy of Neurology’s 65th Annual Meeting; March 16-23, 2013; San Diego. Abstract S40.001.
2. Joshi S, Burch R, Loder E. Migraine with aura and new combined hormonal contraceptives: a retrospective analysis of thrombotic events. In: Program and abstracts of the American Academy of Neurology’s 65th Annual Meeting; March 16-23, 2013; San Diego. Abstract S40.002.