Migraine Not Directly Linked to Traditional Cardiovascular Disease Risk Factors

Author(s):

The study suggests that overall, migraine is not directly related to traditional CVRFs, and further research is needed, especially in younger populations, to explore these relationships over longer periods.

Antoinette Maassen van den Brink, PhD

Published data from the population-based Rotterdam study showed that traditional cardiovascular risk factors (CVRFs) were either unrelated or inversely related to migraine in middle-aged and elderly individuals, but only in females. In the trial, only increased diastolic blood pressure (BP) was related to a higher migraine prevalence in females, further supporting the hypothesis that migraine is not directly associated with common CVRFs.^1,2

Published in Neurology, the study involved 7266 community-dwelling individuals, with a median age of 67 years, of whom 15% had previous or current migraine. Led by senior investigator Antoinette Maassen van den Brink, PhD, of Erasmus University Medical Center in Rotterdam, The Netherlands, the study specifically looked at categorical cardiovascular risk factors that are often modifiable and included in cardiovascular risk scores. In addition, the analysis also included continuous cardiovascular risk factors that are quantitative components of the cardiovascular system (e.g., instead of a categorical hypertension diagnosis, the values of of systolic and diastolic BP).

Among the cohort, there was a difference in migraine prevalence between sexes, as 6.5% (201 of 3085) males reported having active migraine or a history of migraine vs 21.2% (884 of 4181) of females who did the same. In terms of categorical CVRFs, current smoking (OR, 0.72; 95% CI, 0.58-0.89) and diabetes mellitus (OR, 0.75; 95% CI, 0.57-0.99) were statistically significantly associated with a lower migraine prevalence in females only. A third model that contained all categorical cardiovascular risk factors and confounding variables simultaneously also confirmed this association, with ORs of 0.72 (95% CI, 0.58-0.90) for current smoking and 0.74 (95% CI, 0.56-0.98) for diabetes mellitus in solely females.

"Previous research shows that migraine is linked to a higher risk of cardiovascular events such as stroke, heart disease and heart attack, but less is known about how risk factors for cardiovascular events relate to having migraine," Maassen van den Brink said in a statement.¹ "Our study looked at well-known risk factors for cardiovascular disease, such as diabetes, smoking, obesity and high cholesterol and found an increased odds of having migraine only in female participants with higher diastolic blood pressure."

In the second model, a higher diastolic BP was associated with slightly higher prevalence of migraine (OR per SD increase, 1.13; 95% CI, 1.04-1.22) in females. In the multivariable adjusted third model, the effect estimates of diastolic BP were the highest (OR per SD increase, 1.16; 95% CI, 1.04-1.29) followed by fasting glucose levels (OR per SD increase, 0.90; 95% CI, 0.82-0.98) and finally by pack-years (OR per SD increase, 0.91; 95% CI, 0.84-1.00). These associations were only observed in females, and none of the CVRFs were significantly associated with migraine in males.

"Our study suggests that overall, migraine is not directly related to traditional risk factors for cardiovascular disease," Maassen van den Brink added.¹ "Because we looked at people who were middle-age and older, future studies are needed in younger groups of people who are followed for longer periods of time."

An exploratory analysis on migraine activity status included 351 females (39.5%) and 71 males (35.3%) with active migraine. Among females, those with hypercholesterolemia (OR, 1.24; 95% CI, 1.03-1.50) or hypertension (OR, 1.34; 95% CI, 1.06-1.70) had a higher chance of having a history of migraine. Females with these risk factors showed substantially lower, yet nonsignificant odds of having active migraine.

In this analysis, results showed that current smoking was the only CVRF with lower odds of having both a history of migraine (OR, 0.73; 95% CI, 0.55-0.96) or active migraine (OR, 0.69; 95% CI, 0.51-0.94). As the cohort was substantially older than other study populations, investigators hypothesized that the association of current smoking a lower migraine prevalence stems from lifestyle (behavioral) choices.

"Although a similar pattern would also be expected in males, this sex difference might, apart from the obviously lower statistical power due to the lower prevalence of migraine in males, be related to the differential regulation of TRPA1 channels in males and females," the study authors wrote.² "Alternatively, gender-related and social factors or cultural norms might also serve as an explanation for the noted disparities, such as the societal acceptance of smoking among elderly men vs women, and the potentially greater acceptance for women to abstain from smoking because of migraine compared with men."

REFERENCES
1. Are cardiovascular risk factors linked to migraine? American Academy of Neurology. July 31, 2024. Accessed August 12, 2024. https://www.eurekalert.org/news-releases/1052629
2. Al-Hassany L, Acarsoy C, Ikram MK, Bos D, Maassen van den Brink A. Sex-specific association of cardiovascular risk factors with migraine: the population-based Rotterdam study. Neurology. 2024;103(4); doi:10.1212/WNL.0000000000209700