Risk Factors for Increased Syncope Risk in Patients With Migraine

Patients with migraine have a higher risk for syncope if they are underweight, regularly consume tea, have diabetes mellitus, or have migraine with aura, a study in Cephalalgia suggests. Additionally, rs11172113 the single-nucleotide polymorphism within the Low Density Lipoprotein Receptor-related protein-1 gene may indicate a risk for syncope in patients with migraine, and comorbid syncope with migraine may also be indicative of psychiatric distress.

Patients with newly diagnosed migraine were recruited from a single headache clinic of a tertiary hospital in Taiwan (n=1593). Approximately, 111 of these patients (7%) had ≥1 episode of syncope in the past year. Questionnaires that gathered information on lifestyle, comorbidity, syncope, headache, suicide, migraine-related disability, and psychological health were completed by all patients. In addition, the patients completed the Migraine Disability Assessment and Hospital Anxiety and Depression Scale questionnaires. A subset of patients also participated in a case-control genome-wide association study to identify migraine susceptibility genes.

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Logistic regression analyses assessed risk factors for syncope, including patient-specific characteristics and migraine susceptibility loci. Additionally, the researchers evaluated the risk for psychological disorders associated with syncope in this patient population.

According to the multivariate-adjusted analysis, variables associated with a higher risk for syncope in this cohort of patients with migraine included being underweight (body mass index <18.5; odds ratio [OR], 1.76; 95% CI, 1.03-3.03; P =.039), regular tea consumption (OR, 1.84; 95% CI, 1.22-2.79; P =.004), having diabetes mellitus (OR, 4.70; 95% CI, 1.58–13.95; P =.005), and having migraine with aura (OR, 1.78; 95% CI, 1.03-3.10; P =.040).

The researchers also observed a recessive genotypic association between risk for syncope and rs11172113 in Low Density Lipoprotein receptor-related protein-1 risk allele C (OR, 4.00; 95% CI, 1.03-15.45; P =.045). In terms of psychological disorders, the incidence of syncope coupled with migraine correlated with a higher risk for depression (OR 1.95; 95% CI, 1.18-3.22) and suicide attempt (OR, 2.85; 95% CI, 1.48-5.48).

Study limitations include the small number of patients with migraine and syncope, as well as the recruitment of patients from a single center in Taiwan.

“The debilitating psychological impact of co-morbid syncope in migraine patients warrants clinical attention of treating physicians,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Kuan AS, Chen SP, Wang YF, et al. Risk factors and psychological impact of syncope in migraine patients [published online July 15, 2019]. Cephalalgia. doi:10.1177/0333102419865253