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Laura J. Martin, MD
Jan. 15, 2013 -- Women who have migraine with aura may have a higher risk of heart attacks, and they may face a higher risk of dangerous blood clots if they use certain hormonal contraceptives.
Those are the findings from two newly published studies to be presented in March at the 65th annual meeting of the American Academy of Neurology in San Diego.
Migraine with aura refers to migraine headaches that are preceded by visual or other sensory symptoms such as flashing lights, blind spots, smell distortion, numbness, or tingling of the hands and face.
About 1 in 4 people with migraines have this type of migraine.
In the first study, having migraine with aura, but not regular migraines, was a risk factor for heart attacks among middle-aged and older women.
The analysis included data on close to 28,000 women enrolled in the ongoing Women’s Health Study.
During 15 years of follow-up, about 1,400 women who had migraine with aura were identified, and there were 1,030 heart attacks, strokes, or deaths from cardiovascular causes.
After having high blood pressure, having migraine with aura was found to be the second strongest contributor to heart attack and stroke risk, according to researcher Tobias Kurth, MD, of Brigham and Women’s Hospital in Boston and the French National Institute of Health.
Migraine with aura was found in the study to be a bigger risk factor for these cardiovascular conditions than having a family history of early heart disease or having diabetes or being obese or a smoker.
“We have known that migraine with aura is associated with cardiovascular risk,” neurologist and migraine specialist Noah Rosen, MD, says. “What is striking about this study is that it shows just how big this risk is.”
Rosen directs the Headache Center at the Cushing Neuroscience Institute, of the North Shore-LIJ Health System in Manhasset, N.Y.
In the second study, women with migraines who used combined hormonal contraceptives had a higher risk for dangerous deep vein blood clots, and the risk was highest in women with migraine with aura. Combined hormonal contraceptives contain both estrogen and progestin.
While there was a suggestion that newer-generation combined hormonal contraceptives might carry a greater risk for blood clots, researcher Shivang Joshi, MD, of Boston’s Brigham and Women’s Faulkner Hospital, says the difference among users of newer- and older-generation hormonal contraceptives was not that great.
Joshi and colleagues examined the impact of migraine type and combined hormonal contraception type on blood clot risk using data from a health insurance registry that included women enrolled between 2001 and 2012.
The researchers identified around 145,000 women who used combined hormonal contraceptives, including 2,691 who had migraines with aura and 3,437 who had migraines without aura.
More blood clots and related complications were seen with both newer and older hormonal contraceptives in women with migraine with aura, compared to women with migraine without aura.
And rates of these complications were higher in migraine patients who used combined hormonal contraceptives than in women without migraines who used them.
But Joshi says more research is needed to understand the impact of newer and older combined hormonal contraceptives on blood clot risk.
In the meantime, the message to women with migraines considering hormonal contraceptives is "talk to your doctor," Joshi says.
Rosen says both studies also point to the importance of receiving an accurate migraine diagnosis.
“Only about half of people with migraines ever get diagnosed,” he says. “We now know that it is important to have a diagnosis not only for the treatment of the migraine but to understand the risk for other conditions.”
The study by Kurth and colleagues was supported by the National Institutes of Health. The study by Joshi and colleagues was supported by the Graham Headache Center Research Fund.
SOURCES:Sidney, S. Contraception, January 2013.Academy of Neurology 65th Annual Meeting, San Diego, March 16-23, 2013.Shivang Joshi, MD, MPH, Brigham and Women’s Faulkner Hospital, Boston.Noah Rosen, MD, director, Headache Center, Cushing Neuroscience Institute, North Shore-LIJ Health System, Manhasset, N.Y.News release, American Academy of Neurology.
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