Total Cholesterol May Influence Cardiovascular Risk in Patients With Migraine

A team of researchers conducted a systematic review to examine the association between migraine and lipid profile differences.

Patients with migraine may have higher total cholesterol (TC) and triglyceride (TG) concentrations than healthy patients with comparable body mass index (BMI) values, according to study results published in Headache.

Study researchers conducted a systematic review consisting of the first meta-analysis to quantify differences in lipid profiles of patients with migraine (both with [MWA] and without [MWoA] auras) and healthy controls (HC) in individuals naïve to lipid-lowering agents and no known history or secondary causes of dyslipidemia (apart from subjectively assessed lifestyle parameters).

They searched several databases for case-control, cross-sectional, and cohort studies published before September 15, 2020 that involved HC and patients with migraine who reported levels of TC, TG, serum low-density lipoprotein (LDL-C) or high-density lipoprotein cholesterol (HDL-C). Studies’ participants did not have known dyslipidemia or secondary causes of dyslipidemia. Researchers selected 16 case-control and 1 cross-sectional study of adults and conducted subgroup analyses of migraine type and direct comparisons.

Patients with migraine had higher levels of serum TC based on the mean difference (MD) across 14 studies (P <0.1; I2, 85%; MD, 10.6 mg/dl; 95% CI, 1.8-19.3). MD across 15 combined studies indicated that individuals with migraine had significantly higher TG levels than their HC counterparts (P <0.1; I2, 67%; MD, 11.8 mg/dl; 95% CI, 3.6-20.0), which was also seen in sensitivity analyses. However, the TG values for the migraine groups did not exceed the threshold of 2 mmol/L (about 177 mg/dl). In patients with such TG levels, reductions as small as 0.1 mmol/L (about 8.9 mg/dl) can provide clinical benefit. There was no significant difference for either TC or TG between patients with MWA and those with MWoA.

Compared to the HC group, patients with migraine had similar HDL-C levels, according to the MD found across 14 studies (P <0.1; I2, 70%; MD, -0.4 mg/dl; 95% CI, -2.2-1.5 [for mmol/L multiply by 0.0259]), which was also seen in sensitivity analysis and subgroup analyses.

In sensitivity analysis, after excluding studies that did not present comparable BMI values between groups, there was no significant difference in LDL-C between patients with migraine and HC (P <0.1; I2, 70%; MD, 5.3 mg/dl; 95% CI, -0.1-10.8). Subgroup analyses according to the type of migraine also showed no difference between the 2 groups ([for MWA: P <0.1; I2, 93%; MD, 16.9 mg/dl, 95% CI, -4.6-38.3]; [for MWoA: P <0.1; I2, 96%; MD, 14.0 mg/dl, 95% CI, -4.0-32.0]).

Limitations of the study included possibly limited generalizability since most retrieved studies were performed in Turkey, exclusion of 1 case-control study that indicated higher LDL-C levels for migraine patients, and the possibility that migraine patients are a biased sample.

The study researchers concluded, “TC abnormalities may provide part of the explanation for the unfavorable cardiovascular profile of migraine patients.” “Lifestyle,” they added, “may be partly or entirely accountable for the determined increased serum TC. Additional studies that will completely address the effect that lifestyle parameters exert on lipid concentrations are required to better capture existing abnormalities.”


Liampas I, Mylonas KS, Brotis A, et al. Serum lipid abnormalities in migraine: A meta-analysis of observational studies. Headache. Published online January 4, 2021. doi:10.1111/head.14039