Migraine with aura is a risk factor for cardiovascular and cerebrovascular disease: A critically appraised topic

OBJECTIVE: To determine whether migraine with aura and migraine without aura are independent risk factors for symptomatic cardiovascular and cerebrovascular disease. METHODS: We addressed the objective through development of a structured critically appraised topic that included a clinical scenario, structured question, search strategy, critical appraisal, results, summary of best evidence, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarians, and clinical content experts. RESULTS: A prospective cohort study of 27,840 participants in the Women's Health Study determined that, compared with women lacking a migraine history, women who reported active migraine with aura had adjusted hazard ratios of 2.15 (95% confidence interval [CI], 1.58-2.92) for major cardiovascular disease, 1.91 (95% CI, 1.17-3.10) for ischemic stroke, 1.74 (95% CI, 1.23-2.46) for coronary revascularization, 1.71 (95% CI, 1.16-2.53) for angina, and 2.33 (95% CI, 1.21-4.51) for ischemic cardiovascular disease death. Active migraine without aura was not associated with increased risk of any of the vascular event categories. CONCLUSION: In women, active migraine with aura increases the risk of major CVD and ischemic stroke by approximately 2-fold compared with women without migraine. Active migraine without aura was not a risk factor for major CVD and stroke outcomes in this study. Additional emphasis on identification and treatment of modifiable vascular disease risk factors for women with active migraine with aura is warranted.