Migraine Headache and Long-Term Cardiovascular Outcomes: An Extended Follow-Up of the Women's Ischemia Syndrome Evaluation

Published:January 18, 2017DOI:



      The association between migraine headache and cardiovascular events has been inconsistent. This study determines the long-term risk of cardiovascular events among women with and without a history of migraine headache who were under evaluation for suspected myocardial ischemia in the Women's Ischemia Syndrome Evaluation (WISE).


      The WISE is a National Heart, Lung and Blood Institute-sponsored prospective, multicenter study that aims to improve myocardial ischemia evaluation in women. A total of 936 women presenting with symptoms of myocardial ischemia underwent structured data collection and coronary angiography. Information pertaining to migraine headache was available in 917 women. All-cause mortality data were available on all women for a median of 9.5 years, and nonfatal cardiovascular event data were available on 888 women for a median of 6.5 years.


      A total of 224 (24.4%) women reported a history of migraine headache. Compared with women who did not report a history of migraine headache, women with a history of migraine headache had an increased adjusted risk of cardiovascular event (cardiovascular death, nonfatal myocardial infarction, heart failure, or stroke) (hazard ratio 1.83; 95% confidence interval, 1.22-2.75) at a median follow-up of 6.5 years. This result was driven mainly by a twofold increase in the risk of stroke (hazard ratio 2.33; 95% confidence interval, 1.16-4.68).


      Among women being evaluated for ischemic heart disease, those reporting a history of migraine headache had increased risk of future cardiovascular events on long-term follow-up. This risk was primarily driven by a more-than twofold increase in the risk of stroke.


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        • Burch R.C.
        • Loder S.
        • Loder E.
        The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies.
        Headache. 2015; 55: 21-34
        • Schurks M.
        • Rist P.M.
        • Shapiro R.E.
        • Kurth T.
        Migraine and mortality: a systematic review and meta-analysis.
        Cephalalgia. 2011; 31: 1301-1314
        • Gudmundsson L.S.
        • Scher A.I.
        • Aspelund T.
        • et al.
        Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study.
        BMJ. 2010; 341: c3966
        • Kurth T.
        • Gaziano M.
        • Cook N.R.
        • Logroscino G.
        • Diener H.C.
        • Buring J.E.
        Migraine and risk of cardiovascular disease in women.
        JAMA. 2006; 296: 283-291
        • Kurth T.
        • Winter A.C.
        • Eliassen A.H.
        • et al.
        Migraine and risk of cardiovascular disease in women: prospective cohort study.
        BMJ. 2016; 353: i2610
        • Ahmed B.
        • Bairey Merz C.N.
        • McClure C.
        • et al.
        • WISE Study Group
        Migraines, angiographic coronary artery disease and cardiovascular outcomes in women.
        Am J Med. 2006; 119: 670-675
        • Bairey Merz C.N.
        • Kelsey S.F.
        • Pepine C.J.
        • et al.
        The Women's Ischemia Syndrome Evaluation (WISE) study: protocol design, methodology and feasibility report.
        J Am Coll Cardiol. 1999; 33: 1453-1461
        • Chambless L.E.
        • Folsom A.R.
        • Richey Sharrett A.
        • et al.
        Coronary heart disease risk prediction in the Atherosclerosis Risk in Communities (ARIC) study.
        J Clin Epidemiol. 2003; 56: 880-890
        • Folsom A.R.
        • Chambless L.E.
        • Duncan B.B.
        • Gilbert A.C.
        • Pankow J.S.
        • Atherosclerosis Risk in Communities Study Investigators
        Prediction of coronary heart disease in middle-aged adults with diabetes.
        Diabetes Care. 2003; 26: 2777-2784
        • Sharaf B.L.
        • Pepine C.J.
        • Kerensky R.A.
        • et al.
        Detailed angiographic analysis of women with suspected ischemic chest pain (pilot phase data from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation [WISE] Study Angiographic Core Laboratory).
        Am J Cardiol. 2001; 87: 937-941
        • Henrich J.B.
        • Horwitz R.I.
        A controlled study of ischemic stroke risk in migraine patients.
        J Clin Epidemiol. 1989; 42: 773-780
        • Kurth T.
        • Slomke M.A.
        • Kase C.S.
        • et al.
        Migraine, headache, and the risk of stroke in women: a prospective study.
        Neurology. 2005; 64: 1020-1026
        • Etminan M.
        • Takkouche B.
        • Isorna F.C.
        • Samii A.
        Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies.
        BMJ. 2005; 330: 7482
        • Stang P.E.
        • Carson A.P.
        • Rose K.M.
        • et al.
        Headache, cerebrovascular symptoms, and stroke: the Atherosclerosis Risk in Communities Study.
        Neurology. 2005; 64: 1573-1577
        • Spector J.T.
        • Khan S.R.
        • Jones M.R.
        • Jayakumar M.
        • Dalal D.
        • Nazarian S.
        Migraine headache and ischemic stroke risk: an updated meta-analysis.
        Am J Med. 2010; 123: 612-624
        • Kurth T.
        • Schurks M.
        • Logroscino G.
        • Buring J.E.
        Migraine frequency and risk of cardiovascular disease in women.
        Neurology. 2009; 73: 581-588
        • Donaghy M.
        • Chang C.
        • Poulter N.
        • European Collaborators of the World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
        Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age.
        J Neurol Neurosurg Psychiatry. 2002; 73: 747-750
        • Rutledge T.
        • Linke S.E.
        • Krantz D.S.
        • et al.
        Comorbid depression and anxiety symptoms as predictors of cardiovascular events: Results from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study.
        Psychosom Med. 2009; 71: 958-964