Migraine and cardiovascular disease

Systematic review and meta-analysis

Markus Schürks, Pamela M. Rist, Marcelo E. Bigal, Julie E. Buring, Richard B. Lipton, Tobias Kurth

Research output: Contribution to journalArticle

422 Citations (Scopus)

Abstract

Objective: To evaluate the association between migraine and cardiovascular disease, including stroke, myocardial infarction, and death due to cardiovascular disease. Design: Systematic review and meta-analysis. Data sources: Electronic databases (PubMed, Embase, Cochrane Library) and reference lists of included studies and reviews published until January 2009. Selection criteria: Case-control and cohort studies investigating the association between any migraine or specific migraine subtypes and cardiovascular disease. Review methods: Two investigators independently assessed eligibility of identified studies in a two step approach. Disagreements were resolved by consensus. Studies were grouped according to a priori categories on migraine and cardiovascular disease. Data extraction: Two investigators extracted data. Pooled relative risks and 95% confidence intervals were calculated. Results: Studies were heterogeneous for participant characteristics and definition of cardiovascular disease. Nine studies investigated the association between any migraine and ischaemic stroke (pooled relative risk 1.73, 95% confidence interval 1.31 to 2.29). Additional analyses indicated a significantly higher risk among people who had migraine with aura (2.16, 1.53 to 3.03) compared with people who had migraine without aura (1.23, 0.90 to 1.69; meta-regression for aura status P=0.02). Furthermore, results suggested a greater risk among women (2.08, 1.13 to 3.84) compared with men (1.37, 0.89 to 2.11). Age less than 45 years, smoking, and oral contraceptive use further increased the risk. Eight studies investigated the association between migraine and myocardial infarction (1.12, 0.95 to 1.32) and five between migraine and death due to cardiovascular disease (1.03, 0.79 to 1.34). Only one study investigated the association between women who had migraine with aura and myocardial infarction and death due to cardiovascular disease, showing a twofold increased risk. Conclusion: Migraine is associated with a twofold increased risk of ischaemic stroke, which is only apparent among people who have migraine with aura. Our results also suggest a higher risk among women and risk was further magnified for people with migraine who were aged less than 45, smokers, and women who used oral contraceptives. We did not find an overall association between any migraine and myocardial infarction or death due to cardiovascular disease. Too few studies are available to reliably evaluate the impact of modifying factors, such as migraine aura, on these associations.

Original languageEnglish (US)
Pages (from-to)1015
Number of pages1
JournalBMJ (Online)
Volume339
Issue number7728
DOIs
StatePublished - Oct 31 2009

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Migraine Disorders
Meta-Analysis
Cardiovascular Diseases
Migraine with Aura
Myocardial Infarction
Stroke
Oral Contraceptives
Epilepsy
Research Personnel
Confidence Intervals
Migraine without Aura
Information Storage and Retrieval
PubMed
Patient Selection
Libraries
Case-Control Studies
Consensus
Cohort Studies
Smoking
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Schürks, M., Rist, P. M., Bigal, M. E., Buring, J. E., Lipton, R. B., & Kurth, T. (2009). Migraine and cardiovascular disease: Systematic review and meta-analysis. BMJ (Online), 339(7728), 1015. https://doi.org/10.1136/bmj.b3914

Migraine and cardiovascular disease : Systematic review and meta-analysis. / Schürks, Markus; Rist, Pamela M.; Bigal, Marcelo E.; Buring, Julie E.; Lipton, Richard B.; Kurth, Tobias.

In: BMJ (Online), Vol. 339, No. 7728, 31.10.2009, p. 1015.

Research output: Contribution to journalArticle

Schürks, M, Rist, PM, Bigal, ME, Buring, JE, Lipton, RB & Kurth, T 2009, 'Migraine and cardiovascular disease: Systematic review and meta-analysis', BMJ (Online), vol. 339, no. 7728, pp. 1015. https://doi.org/10.1136/bmj.b3914
Schürks, Markus ; Rist, Pamela M. ; Bigal, Marcelo E. ; Buring, Julie E. ; Lipton, Richard B. ; Kurth, Tobias. / Migraine and cardiovascular disease : Systematic review and meta-analysis. In: BMJ (Online). 2009 ; Vol. 339, No. 7728. pp. 1015.
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abstract = "Objective: To evaluate the association between migraine and cardiovascular disease, including stroke, myocardial infarction, and death due to cardiovascular disease. Design: Systematic review and meta-analysis. Data sources: Electronic databases (PubMed, Embase, Cochrane Library) and reference lists of included studies and reviews published until January 2009. Selection criteria: Case-control and cohort studies investigating the association between any migraine or specific migraine subtypes and cardiovascular disease. Review methods: Two investigators independently assessed eligibility of identified studies in a two step approach. Disagreements were resolved by consensus. Studies were grouped according to a priori categories on migraine and cardiovascular disease. Data extraction: Two investigators extracted data. Pooled relative risks and 95{\%} confidence intervals were calculated. Results: Studies were heterogeneous for participant characteristics and definition of cardiovascular disease. Nine studies investigated the association between any migraine and ischaemic stroke (pooled relative risk 1.73, 95{\%} confidence interval 1.31 to 2.29). Additional analyses indicated a significantly higher risk among people who had migraine with aura (2.16, 1.53 to 3.03) compared with people who had migraine without aura (1.23, 0.90 to 1.69; meta-regression for aura status P=0.02). Furthermore, results suggested a greater risk among women (2.08, 1.13 to 3.84) compared with men (1.37, 0.89 to 2.11). Age less than 45 years, smoking, and oral contraceptive use further increased the risk. Eight studies investigated the association between migraine and myocardial infarction (1.12, 0.95 to 1.32) and five between migraine and death due to cardiovascular disease (1.03, 0.79 to 1.34). Only one study investigated the association between women who had migraine with aura and myocardial infarction and death due to cardiovascular disease, showing a twofold increased risk. Conclusion: Migraine is associated with a twofold increased risk of ischaemic stroke, which is only apparent among people who have migraine with aura. Our results also suggest a higher risk among women and risk was further magnified for people with migraine who were aged less than 45, smokers, and women who used oral contraceptives. We did not find an overall association between any migraine and myocardial infarction or death due to cardiovascular disease. Too few studies are available to reliably evaluate the impact of modifying factors, such as migraine aura, on these associations.",
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