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Review
. 2009 Oct 27;339:b3914.
doi: 10.1136/bmj.b3914.

Migraine and Cardiovascular Disease: Systematic Review and Meta-Analysis

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Free PMC article
Review

Migraine and Cardiovascular Disease: Systematic Review and Meta-Analysis

Markus Schürks et al. BMJ. .
Free PMC article

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.

Conflict of interest statement

Competing interests: MS has received an investigator initiated research grant from the Deutsche Forschungsgemeinschaft and honorariums from LEK Consulting for telephone surveys. MEB is a full time employee of Merck Research Laboratories; he has carried out research, been on the advisory board, or has been in the speaker’s bureau of several pharmaceutical companies that market drugs for migraine. JEB has received investigator initiated research funding and support from the National Institutes of Health and Dow Corning; research support for pills or packaging from Bayer Heath Care and the Natural Source Vitamin E Association; and an honorarium from Bayer for speaking engagements. RBL has consulted for, carried out studies funded by, or received lecture honorariums from Merck and other companies including Allergan, GlaxoSmithKline, Johnson and Johnson, Minster, and Neuralieve. He has stock options in Minster and Neuralieve. TK has received investigator initiated research funding from the National Institutes of Health, McNeil Consumer & Specialty Pharmaceuticals, Merck, and Wyeth Consumer Healthcare; he is a consultant to i3 Drug Safety and World Health Information Science Consultants, LLC, and he has received honorariums from Genzyme, Merck, and Pfizer for educational lectures.

Figures

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Fig 1 Process of study selection
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Fig 2 Association between any migraine and ischaemic stroke (all studies)
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Fig 3 Funnel plot for studies investigating association between any migraine and ischaemic stroke
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Fig 4 Association between migraine with and without aura and ischaemic stroke
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Fig 5 Association between any migraine and myocardial infarction
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Fig 6 Association between any migraine and death due to cardiovascular disease

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