Cardiovascular

Migraines and cardiovascular disease: mechanisms and methodological challenges

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The link between migraine and cardiovascular disease is complex and involves overlapping mechanisms, such as endovascular disturbances. Challenges in measuring migraine, in distinguishing between causation and prediction, and in the understanding of clinical implications highlight the need for further research to guide treatment and cardiovascular risk assessment for the millions of individuals living with migraine.

The link between migraine, a common chronic primary headache disorder, and an increased risk of cardiovascular disease (CVD) has been known for decades1,2. The relationship between migraine — especially migraine with aura (a complex of neurological symptoms, predominantly visual disturbances, that precede the migraine headache) — and an increased risk of ischaemic stroke is well-established. Moreover, emerging data suggest an increased risk of myocardial infarction and cardiovascular death among individuals who experience migraine1. In light of this evidence, there is growing awareness that migraine might be a marker of cardiovascular risk. However, whether this link is as straightforward as it seems or whether we are missing nuances that could change the way we perceive and approach this relationship are unknown. To answer these questions, four factors need to be carefully considered: the lack of a clear and direct mechanism that links migraine with CVD; the distinction between migraine as a risk factor for versus a predictor of CVD; methodological challenges to classify and measure migraine at the population level; and potential clinical implications.

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Authors and Affiliations

  1. Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Tobias Kurth & Pamela M. Rist

  2. Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Tobias Kurth & Pamela M. Rist

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  1. Tobias Kurth
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T.K. has received research grants from the Gemeinsamer Bundesausschuss (G-BA – Federal Joint Committee, Germany) and the Bundesministerium für Gesundheit (BMG – Federal Ministry of Health, Germany), and has received personal fees from BMJ, Eli Lilly and Company and Frontiers. P.R. has received research grants from the National Institutes of Health, Brigham and Women’s Hospital and the American Heart Association (AHA), and has received personal compensation from the AHA for editorial work.

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Kurth, T., Rist, P.M. Migraines and cardiovascular disease: mechanisms and methodological challenges.
Nat Rev Cardiol (2023). https://doi.org/10.1038/s41569-023-00934-7

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  • Published: 18 September 2023

  • DOI: https://doi.org/10.1038/s41569-023-00934-7

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