From Medscape Medical News

Migraine With Aura Linked to Increased Mortality From Stroke and Heart Disease

Fran Lowry

August 26, 2010 — Migraine, particularly migraine with aura, is associated with an increased risk for death from cardiovascular disease and hemorrhagic stroke, according to the findings of 2 large prospective cohort studies.

But, the researchers emphasize, the individual risk for those with migraine is low. The reports, which add more weight to previous data suggesting this link, were published online August 25 in the British Medical Journal.

Reykjavik Study

In the first study, Larus S. Gudmundsson, a doctoral student from the University of Iceland in Reykjavik, and colleagues assessed the impact of midlife migraine episodes in 18,725 men and women born between 1907 and 1935.

The study cohort was part of the Reykjavik Study, which was started in 1967 by the Icelandic Heart Association to prospectively study cardiovascular disease in Iceland. Participants were followed up for up to 40 years, until the end of 2007. The median follow-up was 25.9 years. In total, the researchers assessed 470,990 person-years of data and used questionnaires to assess migraine with and without aura.

Overall, there were 10,358 deaths, 4323 from cardiovascular disease and 6035 from other causes.

After adjusting for baseline risk factors, age, and sex, the study found that people with migraine with aura were at increased risk for all-cause mortality and mortality from cardiovascular disease compared with people with no headache. No increased risk was found for people with migraine without aura and people with nonmigraine headache.

A closer look at death from cardiovascular disease revealed that people with migraine with aura were at increased risk for mortality from coronary heart disease and stroke.

Table. Mortality Risk for Migraine With Aura vs No Headache

Endpoint Adjusted Hazard Ratio (95% CI)
All-cause mortality 1.21 (1.12 – 1.30)
Cardiovascular disease mortality 1.27 (1.13 – 1.43)
Coronary heart disease mortality 1.28 (1.11 – 1.49)
Stroke mortality 1.40 (1.10 – 1.78)

CI = confidence interval

The study also showed that women with migraine with aura were at increased risk for mortality from noncardiovascular disease (hazard ratio, 1.19; 95% confidence interval, 1.06 – 1.35).

Explaining the clinical significance of the findings, Gudmundsson told Medscape Medical News, “Although our study shows that migraine and in particular migraine with aura is an independent risk factor for all-cause and cardiovascular disease mortality, the risk is low compared to conventional modifiable risk factors, such as smoking, adverse blood lipid profile, and hypertension. Having migraine with aura should be an additional reason for monitoring your modifiable risk factors and keeping them in check, and this applies to both men and women.”

He added that future studies will determine whether reducing migraine or aura frequency with medication or other interventions will lower the risk for cardiovascular disease in these individuals. [emphasis added]

Comments from Dr. Chapman:

More and more studies are showing the potential relationship between various pathologies and disorders. Here we have two major “players” when it comes to human suffering; migraines with aura and an increases in mortality not only from stroke, but due to other “non-cardiovascular related disorders”.

This very long and careful study clearly shows the correlation between Aura Associated Migraines (AAM) and mortality from cardiovascular disease, like stroke—but it also makes a finer more interesting point: The study could draw our thinking into more holistic and connected patterns of clinical reasoning, wherein we as physicians, might begin to make some fundamental observations about the potential common causes of disease.

Understanding this could create a new discussion for treatment. For instance, NUCCA research has shown a clear relationship between hypertension and the Atlas subluxation (see WebMD article: ). It also shows a correlation between Atlas subluxation and headaches of all varieties, including migraines with and without aura. (See Journal of Man. Ther. 1999; 7(1):33-39, Man. Physiol Ther, 1980; 3(3):137, Cephalgia 1987; 7(2):147-160) The Reykjavik Study suggests that both migraines and hypertension may  be a different tangent of expression by the body for potentially the same underlying problem or condition. “Chronic Anything” indicates some underlying imbalance.

So, if we follow this clinical reasoning, then potentially correcting the underlying problem which is CAUSING both migraines and hypertension could lead to a reduction in mortality rates. (Wisely, the author left the notion on the table that “interventions”, (including drugs of course) in the conditions may reduce risks, thereby reducing mortality rates) In plain English—you just may live longer and happier when you are in proper spinal alignment–without drugs.

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