Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study

doi:10.1212/WNL.0000000000006650

. 2018 Dec 11;91(24):e2202-e2210.

doi: 10.1212/WNL.0000000000006650. Epub 2018 Nov 14.

Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study

Affiliations

¹ From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill. Souvik.Sen@uscmed.sc.edu.
² From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill.

PMID: 30429278
PMCID: PMC6329332
DOI: 10.1212/WNL.0000000000006650

Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study

Souvik Sen et al. Neurology. 2018.

. 2018 Dec 11;91(24):e2202-e2210.

doi: 10.1212/WNL.0000000000006650. Epub 2018 Nov 14.

Affiliations

¹ From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill. Souvik.Sen@uscmed.sc.edu.
² From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill.

PMID: 30429278
PMCID: PMC6329332
DOI: 10.1212/WNL.0000000000006650

Abstract

Objective: Migraine with visual aura is associated with cardioembolic stroke risk. The aim of this study was to test association between migraine with visual aura and atrial fibrillation (AF), in the Atherosclerosis Risk in Communities study.

Methods: In the Atherosclerosis Risk in Communities study, a longitudinal, community-based cohort study, participants were interviewed for migraine history in 1993-1995 and were followed for incident AF through 2013. AF was adjudicated using ECGs, discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Mediation analysis was conducted to test whether AF was a mediator of migraine with visual aura-associated stroke risk.

Results: Of 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraines with visual aura, 1,090 migraine without visual aura, 1,018 nonmigraine headache, and 9,405 no headache. Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1,516 with migraine and 1,623 (17%) of 9,405 without headache. After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache (hazard ratio 1.30, 95% confidence interval 1.03-1.62) as well as when compared to migraine without visual aura (hazard ratio 1.39, 95% confidence interval 1.05-1.83). The data suggest that AF may be a potential mediator of migraine with visual aura-stroke risk.

Conclusions: Migraine with aura was associated with increased risk of incident AF. This may potentially lead to ischemic strokes.

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Figures

**Figure 1. Kaplan-Meier curves depicting 20-year outcome of incident atrial fibrillation in participants with migraine headache and those without headache**
Inset: log rank p value.

**Figure 2. Kaplan-Meier curves depicting 20-year outcome of incident atrial fibrillation in participants with migraine with visual aura and those with migraine without aura**
Inset: crude and adjusted hazard ratios (HRs) along with 95% confidence intervals (CIs) are indicated in the left bottom. Log rank p value is indicated in the right bottom.

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Comment in

Migraine with visual aura, incident AF, and stroke risk: Is migraine with aura an embolic TIA?
Fridman S, Sposato LA. Fridman S, et al. Neurology. 2018 Dec 11;91(24):1077-1078. doi: 10.1212/WNL.0000000000006637. Epub 2018 Nov 14. Neurology. 2018. PMID: 30429280 No abstract available.
Reader response: Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study.
Gupta V. Gupta V. Neurology. 2019 Oct 1;93(14):645-646. doi: 10.1212/WNL.0000000000008202. Neurology. 2019. PMID: 31570641 No abstract available.
Reader response: Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study.
Hsieh CY. Hsieh CY. Neurology. 2019 Oct 1;93(14):646. doi: 10.1212/WNL.0000000000008210. Neurology. 2019. PMID: 31570642 No abstract available.
Author response: Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study.
Sen S. Sen S. Neurology. 2019 Oct 1;93(14):646-647. doi: 10.1212/WNL.0000000000008211. Neurology. 2019. PMID: 31570643 No abstract available.

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References

1. Hu X, Zhou Y, Zhao H, et al. . Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies. Neurol Sci 2017;38:33–40. - PubMed
1. Stang PE, Carson AP, Rose KM, et al. . Headache, cerebrovascular syndromes, and stroke: the Atherosclerosis Risk in Communities study. Neurology 2005;64:1573–1577. - PubMed
1. Androulakis XM, Kodumuri N, Giamberardino L, et al. . Ischemic stroke subtypes and relationship with migraine with aura in the ARIC study. Neurology 2016;87:2527–2532. - PMC - PubMed
1. Adelborg K, Szépligeti SK, Holland-Bill L, et al. . Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ 2018;360:k96. - PMC - PubMed
1. Sposato LA, Peterlin BL. Cardioembolism as the unsuspected missing link between migraine and ischemic stroke. Neurology 2016;87:2504–2505. - PubMed

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[1] Hu X, Zhou Y, Zhao H, et al. . Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies. Neurol Sci 2017;38:33–40. - PubMed

[2] Hu X, Zhou Y, Zhao H, et al. . Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies. Neurol Sci 2017;38:33–40. - PubMed

[3] Stang PE, Carson AP, Rose KM, et al. . Headache, cerebrovascular syndromes, and stroke: the Atherosclerosis Risk in Communities study. Neurology 2005;64:1573–1577. - PubMed

[4] Stang PE, Carson AP, Rose KM, et al. . Headache, cerebrovascular syndromes, and stroke: the Atherosclerosis Risk in Communities study. Neurology 2005;64:1573–1577. - PubMed

[5] Androulakis XM, Kodumuri N, Giamberardino L, et al. . Ischemic stroke subtypes and relationship with migraine with aura in the ARIC study. Neurology 2016;87:2527–2532. - PMC - PubMed

[6] Androulakis XM, Kodumuri N, Giamberardino L, et al. . Ischemic stroke subtypes and relationship with migraine with aura in the ARIC study. Neurology 2016;87:2527–2532. - PMC - PubMed

[7] Adelborg K, Szépligeti SK, Holland-Bill L, et al. . Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ 2018;360:k96. - PMC - PubMed

[8] Adelborg K, Szépligeti SK, Holland-Bill L, et al. . Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ 2018;360:k96. - PMC - PubMed

[9] Sposato LA, Peterlin BL. Cardioembolism as the unsuspected missing link between migraine and ischemic stroke. Neurology 2016;87:2504–2505. - PubMed

[10] Sposato LA, Peterlin BL. Cardioembolism as the unsuspected missing link between migraine and ischemic stroke. Neurology 2016;87:2504–2505. - PubMed

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Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study

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Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study

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