Jul 14, 2016

Interview Transcript

Dr. Jones: Migraine headaches are common. About 15-20% of women have migraine. Now, cardiovascular disease is common and, yes, it's common in women. Is there a relationship between these two common problems? This week, in the British Journal of Medicine, a study was reported to suggest that there is. So let's look at the study, the numbers and what you should do about it.

Announcer: Covering all aspects of Women's Health. This is "The Seven Domains of Women's Health," with Dr. Kirtly Jones on The Scope.

Dr. Jones: The study was an analysis of the Nurses' Health Study, the biggest study ever done on women as they age. It started in 1989 and enrolled nurses, a lot of nurses, over 100,000 nurses, and followed them for more than 20 years. Although the study was published in the British Journal of Medicine, these were nurses living in the United States.

In this report, they included 115,141 women who were of an average age of 32 years of age and followed for 22 years. They found that 15% of these nurses had migraine and that women with migraine had a 50% increased risk of cardiovascular disease, stroke, heart attacks or procedures to treat coronary artery disease.

This finding of increased incidence of stroke and coronary heart disease in female migrainers has been found in studies of other places. The Women's Health Study, a large study in the US but not as huge as the Nurses' Health Study, found a similar increase as did a study of Taiwanese women and Icelandic women. In this sense, the study is strong as it's backed up by other studies, it's huge in numbers and prospective, meaning it followed women going forward not looking back.

I'm a migrainer, a woman with migraine. I have migraine with aura. The study didn't differentiate migrain with aura versus not, but the Women's Health Study did and found the increase in heart disease only in women with migraine and aura. So I freaked out a tiny bit, but then I got my pencil and a piece of paper and did some little calculations.

So if you like numbers, you can get out your pencil and do some "back of the envelope" calculations with me. Ready? 115,541 women didn't have heart disease at the beginning of this study. 1,329 had a cardiovascular event, stroke, heart attack or surgery to open up their coronary arteries. 1,329 divided by 115,541 is about 1% or 1 in 100. If there was a 50% increase in the migrainers, that would be 1.5 in 100 over 22 years.

That's about one extra cardiovascular event in 200 women with migraine over 22 years. An increase, but not enough to make me lose any sleep, especially because losing sleep increases my risk for heart disease. Remember, these were young women and stroke and cardiovascular disease are not common in women between the ages of 32 and 54, the average age of the nurses in the study at the beginning and then at the end of the follow-up for the study.

So what's the takeaway? First of all, we've long known that migrainers with aura are at increased risk of stroke. But still, these numbers are small. Is there something about migrainers which makes them an increased risk for coronary heart disease as well? Are migrainers overweight? Are they more likely to have high blood pressure? Are they more likely to be poor? The nurses health study followed nurses and, of course, the nurses can be poor, but is less likely. And they controlled for weight and blood pressure. Are women with migraine more likely to be stressed out?

Certainly, any chronically painful condition can increase stress and stress is a risk factor for coronary heart disease. This study couldn't control for stress. Or is it that women with migraines have arteries in their head and body that have more inflammation or changes in the lining in the arteries that make them more prone to stroke or coronary artery disease? Would this association help us understand heart disease in women and give us a clue as to where to look for prevention?

Now, that would be helpful, but what should you do and what should I do as a migrainer to manage my little-increased risk of heart disease and stroke? First, don't freak out. I am not freaking out. That's definitely bad for you and now that you know the numbers, you shouldn't freak out. But everyone should manage their basic manageable risks for heart disease. Manage your weight, exercise, blood pressure and cholesterol.

Should you take out a baby aspirin every day? Something that's been used to decrease the incidence of migraine and, in men, decreases the risk of coronary heart disease? It didn't seem to work in this study, as women who took aspirin didn't have a lower risk of heart disease. So there you go.

The best idea for what to do comes from the editorial in the British Medical Journal that accompanied this study. And here I quote, "What little evidence we do have suggests the need for therapeutic restraint until we have better understanding of the mechanisms underlying the link between migraine and vascular disease. At present, migraine is probably best thought of as a situation in which the medical urge to do something beyond currently recommended assessments for cardiac risk and advocating healthy lifestyle should be resisted especially when migraine is the patient's sole risk factor."

Don't you just love the Brits? They have such common sense about health care. So for all of you migrainers out there, take a deep, cleansing breath. Go out and take a little walk and thanks for joining us on The Scope.

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