Target Audience (click to view)
This activity is designed to meet the needs of physicians.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Discuss the findings of a study that aimed to determine the association between migraine and stroke and a combination of vascular events, including stroke, heart attack, and death.
- Describe the impact of smoking on the link between stroke and migraine.
- Review needs for future research focused on the link between stroke and migraine.
Method of Participation(click to view)
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at http://akhcme.com/akhcme/lessons/18. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Commercial Support(click to view)
There is no commercial support for this activity.
Disclosures(click to view)
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer(click to view)
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Complete the Post Test(click to view)
Migraines affect more than 10% of all Americans and are three times more common in women than in men, according to data from the National Institute of Neurological Disorders and Stroke (NINDS). Although the link between migraine and stroke is not fully understood, research suggests that the two conditions have some clinical features that overlap. The NINDS has reported that risk factors for stroke with migraine-like features include being female, being older than 40, and having low cardiovascular risk profiles.
Over the years, many studies have suggested that migraine is a risk factor for stroke. Some analyses have shown that stroke risks are twice as high in people who suffer from migraine with aura than those without aura. For women, stroke risks have been reported to be three times higher when they have migraine with aura. “To date, most of the research examining the link between stroke and migraine has shown that there is a correlation in migraineurs with aura,” says Teshamae S. Monteith, MD.
Taking a Deeper Look
For a study published in Neurology, Dr. Monteith and colleagues aimed to determine the association between migraine and stroke and a combination of vascular events, including stroke, heart attack, and death. Participants in the study were from the Northern Manhattan Study, a population-based cohort of stroke incidence. The participants were from an older, ethnically-diverse community in which the population was predominately Hispanic, a patient group that has historically been at a higher risk for stroke. The association between migraine and the combination of vascular events was estimated over an average follow-up of 11 years.
After reviewing 1,292 people who reported suffering from migraine headaches, 187 had migraine without aura (20%) and 75 had migraine with aura (6%). During the study, a total of 294 strokes, heart attacks, and deaths occurred. No association was found between migraine (with or without aura) and the risk of either stroke or the combined cardiovascular events assessed in the study.
Importantly, the study revealed that the hazard ratio of stroke for people with migraine who currently smoked was significantly higher than that of current non-smokers. Regarding the endpoint of combined vascular events, the hazard ratio for migraine versus no migraine among current smokers was also higher than that of current non-smokers (Table).
“Consistent with previous reports, we also found evidence suggesting that patients with migraine were more likely to have hypertension, be physically inactive, smoke, and have higher cholesterol levels,” says Dr. Monteith. “It appears that quitting smoking and addressing other lifestyle issues—even at older ages—may improve vascular outcomes in those with migraine.”
Dr. Monteith says it was relatively surprising that non-smokers with migraine had a lower risk of combined vascular events in the study. “One possible reason for this finding is that patients who did not smoke may be more health conscious than others,” she says. “It’s possible that these people avoided other lifestyle behaviors that can trigger migraines, resulting in better overall health, but further work is needed in this area.”
Taking the Next Step
Findings from the study provide more evidence as to why quitting smoking is critically important for people who suffer with migraines, according to Dr. Monteith. While the study of migraine and vascular events in older people found that only smokers with migraine had an increased risk of stroke, earlier studies have shown that women younger than 45 who have migraine with aura are also at an increased risk of stroke, regardless of whether or not they smoke.
“As clinicians, it’s important that we focus our efforts to manage chronic illnesses and emphasize the importance of primary prevention, especially for migraine sufferers,” Dr. Monteith says. “More research is needed to take a better look at lifestyle factors that may play a role in stroke risk among migraineurs, including dietary habits. It may also help if we investigate the effect of lifestyle interventions and migraine treatments on vascular outcomes in people with migraine. Additionally, we plan to look at metabolic syndrome in our study cohort, which is a particular problem for Hispanics.”
The Bottom Line
With data suggesting that smoking may be more common among migraineurs, Dr. Monteith says that smoking cessation counseling should be encouraged as a part of routine migraine care at all ages. As patients age, they tend to develop more comorbidities, but this appears to be especially true for individuals with migraine. “People with migraine tend to have more vascular comorbid conditions,” says Dr. Monteith. “As such, interventions should include the management of migraine as well as efforts to reduce vascular risk factors in order to optimize patient outcomes.”
Readings & Resources (click to view)
Monteith TS, Gardener H, Rundek T, Elkind MS, Sacco RL. Migraine and risk of stroke in older adults: Northern Manhattan Study. Neurology. 2015;85:715-721. Available at: http://www.neurology.org/content/85/8/715.short.
Sacco S, Kurth T. Migraine and the risk for stroke and cardiovascular disease. Curr Cardiol Rep. 2014;16:524.
Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener HC, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA. 2006;296:283-291.