gms | German Medical Science

Objectives: We aimed to evaluate the association between migraine with aura and incident cardiovascular disease (CVD) in women stratified by the Framingham Risk Score (FRS) for coronary heart disease.

Methods: We used prospective data from 27,519 women participating in the Women’s Health Study who were free of CVD at baseline and had information on lipid levels and migraine aura status. We stratified participants based on FRS-estimated 10-year risk (<1%, 2-4%, 5-9%, and >10%).

Results: At baseline, 3577 (13.0%) women reported active migraine; 39.7% indicated migraine with aura. After 11 years of follow-up, 665 CVD events occurred. Compared with non-migraineurs, women with migraine with aura had age-adjusted hazard ratios (95% confidence intervals) of 2.01 (1.51-2.67) for major CVD, 1.74 (1.09-2.79) for ischemic stroke, and 2.01 (1.30-3.09) for myocardial infarction. When stratified by FRS, the association between migraine with aura and major CVD was strongest in the low FRS-risk group. However, the association pattern differed for ischemic stroke and myocardial infarction. Compared to non-migraineurs, women who reported migraine with aura in the low FRS-risk group had hazard ratios of 4.48 (2.13-9.44) for ischemic stroke and 0.98 (0.23-4.10) for myocardial infarction. Women with migraine with aura in the highest FRS-risk group had hazard ratios of 0.54 (0.07-3.91) for ischemic stroke and 3.41 (1.52-7.63) for myocardial infarction. Women with migraine without aura did not have increased risk of CVD in any of the FRS risk groups.

Conclusion: Our data indicate that the association between migraine with aura and CVD varies by vascular risk status. The different association pattern for ischemic stroke and myocardial infarction may suggest different biological mechanisms.