MedicalResearch.com Interview with:
Islam Elgendy MD
Division of Cardiovascular Medicine
University of Florida
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Migraine headache is a prevalent medical condition, often being chronic and debilitating to many. Previous studies have shown that migraine, particularly migraine with aura, is associated with an increased risk of cardiovascular events. Recently, a number of these studies have reported long-term follow up data. To better understand the long-term morbidity that is associated with migraines, we performed a systematic evaluation to study the link between migraine and risk of cardiovascular and cerebrovascular events.
This study demonstrated that migraine is associated with an increased risk of major adverse cardiovascular and cerebrovascular events, which was driven by an increased long-term risk of myocardial infarction and stroke. This effect was predominantly observed in migraineurs who have aura.
MedicalResearch.com: What should readers take away from your report?
Response: Our study suggests that migraine, especially migraine with aura, should be considered an independent predictor of future cardiovascular and cerebrovascular events. Migraineurs, especially those with aura, should be informed about this increased risk. Of note, the data for this study were derived from observational cohorts and thus, are subject to unmeasured residual confounding. In addition, migraine was assessed differently across the included studies.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research should focus on identifying the role of antiplatelet and/or statin therapy for primary prevention in these subjects, in an effort to minimize the long-term risk of cardiovascular and cerebrovascular events.
MedicalResearch.com: Is there anything else you would like to add?
Response: Interestingly, patent foramen ovale (PFO) is prevalent (up to 50%) in patients who have migraine with aura. Data regarding the efficacy of percutaneous PFO closure to treat migraine headache remains controversial, but randomized trials have suggested that a subset of migraineurs with frequent aura may experience a reduction in the frequency and duration of migraine attacks. Thus, it would be interesting to understand the impact of PFO closure on future cardiovascular and cerebrovascular events, in these subjects. Moreover, since PFO closure for secondary prevention of cryptogenic stroke is now less controversial with publication of multiple new trials, percutaneous PFO closure may have the collateral effect of improving co-existing migraines when device closure is performed for stroke prevention.
None of the authors have any disclosures or conflict of interest pertaining to this paper.
Mahmoud AN, Mentias A, Elgendy AY, et al
Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects
BMJ Open 2018;8:e020498.
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