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.


Addressing Smoking

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.”