Episodic Migraine Increases Risk for CVD, Subsequent Contraindications to Therapy

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human heart
Clinicians need to consider treatments for episodic migraine that may be contraindicated if a patient also has cardiovascular disease.

A large proportion of patients with episodic migraine (EM) have greater risk for cardiovascular disease with increasing age and subsequently have contraindications to treatment with triptan and ergot medications, according to a study published in Headache.

In this cross-sectional analysis, researchers evaluated patient data from the 2009 American Migraine Prevalence and Prevention (AMPP) study questionnaire. Only those patients from the AMPP who met criteria for EM (n=6723) were included. The investigators used the non-laboratory Framingham cardiovascular disease risk score (FRS) to calculate the 10-year risk for a first cardiovascular disease event.

According to the FRS, approximately 69.5% of women and 73.4% of men with EM featured ≥1 cardiovascular risk factor. A lower proportion of men (19.1%) and women (18.6%) had 3 cardiovascular risk factors, according to the FRS.

Overall, a higher FRS was associated with older age. For ages 22 to 39, 40 to 59, and 60 years, the proportion of women with a high FRS was 0%, 0.8% (95% CI, 0.5-1.2%), and 15.2% (95% CI, 13.3-17.4%), respectively. Comparatively, the corresponding proportions among men with a high FRS were 0, 7.3% (95% CI, 5.7-9.4%), and 53.0% (95% CI, 4.7-58.1%).

Increasing age was associated with a higher proportion of women and men having a risk for future cardiovascular events based on high FRS, in addition to a prior cardiovascular event, conditions, and procedures, or both. For instance, women and men age 20 to 39 years had a 4.5% and 4.2% risk, respectively, compared with women and men age 60 who had a risk of 31.2% and 61.8%, respectively.

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The self-administered questionnaires to evaluate diagnostic variables for migraine and subsequent EM classification represent an important limitation of this study. Additionally, the investigators suggest that their findings may contain underestimation and overestimation of cardiovascular risk.

When making prescription decisions regarding vasoconstrictive compounds or triptans, physicians may need “to calculate a FRS to provide better information, weighing the risks against the benefits of vasoconstrictor therapy in people with EM.”


Lipton RB, Reed ML, Kurth T, Fanning KM, Buse DC. Framingham-based cardiovascular risk estimates among people with episodic migraine in the US population: results from the American migraine prevalence and prevention (AMPP) study. Headache. 2017;57(10):1507-1521.