03 June 2010

Migraines and strokes linked

People who suffer migraines are about twice as likely as people without the painful headaches to suffer a stroke caused by a blood clot, a new research review finds.

People who suffer migraines are about twice as likely as people without the painful headaches to suffer a stroke caused by a blood clot, a new research review finds.

The analysis, which combined the results of 21 previous studies, confirms a connection between migraines and ischemic stroke - the most common form of stroke, occurring when a clot disrupts blood flow to the brain.

Across the studies, migraine sufferers were about twice as likely to suffer an ischemic stroke as people without migraines, according to findings published in the American Journal of Medicine. Experts are not sure why the relationship exists, and it is not yet known whether the migraines themselves directly lead to strokes in some people.

It's likely, however, that a common underlying process contributes to both migraines and stroke risk, said Dr Saman Nazarian, the senior researcher on the new study and an assistant professor at Johns Hopkins University School of Medicine in Baltimore.

For now, he said, the bottom line for migraine sufferers is that they should be particularly vigilant about controlling any modifiable risk factors for stroke that they may have.

Smoking, hypertension, diabetes

Some of those risk factors include high blood pressure, smoking and diabetes.

"The main thing I would want (people) to take away from this is that if they get migraines, they should address stroke risk factors," Nazarian said.

"They should not smoke and they should watch their blood pressure and have it treated if it is high."

Experts also generally say that people with migraines should remember that while the headaches are linked to a relatively increased risk of stroke, the absolute risk to any one person remains fairly low.

In one recent study of 6 100 adults with migraines, for example, 2% reported a history of stroke, versus 1.2% of 5 243 adults who did not suffer from migraines.

The current findings are based on 21 international studies conducted between 1975 and 2007 and involving more than 622 000 adults with and without migraines.

What the studies looked at

Most of the studies took into account a number of factors that might help explain any connection between migraine and stroke risk - such as age, high blood pressure, diabetes, smoking habits and weight. Even with those factors considered, migraines themselves were linked to a two-fold increase in stroke risk when Nazarian's team combined the results of all 21 studies.

The precise cause of migraines is not fully understood, but the pain involves constriction, and then swelling, of brain blood vessels. One theory is that people with migraine may have dysfunction in the blood vessels throughout the body, which may explain the increased risk of stroke and, as some previous studies have found, heart attack.

No one yet knows whether treating and preventing migraine attacks can do anything to affect people's risk of cardiovascular problems.

On one hand, researchers have noted, drugs that prevent migraine attacks could theoretically lower the risk of cardiovascular problems. On the other hand, certain medications might have negative effects; some anti-inflammatory painkillers have been linked to cardiovascular risks, while migraine drugs known as "ergots" tend to constrict blood vessels throughout the body.

The current study received no drug industry funding, according to Nazarian's team, and none of the researchers reports any industry ties.- (Reuters Health, June 2010)


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Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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