Migraine with Aura May Be Linked to Blood Clotting Factors

MedicalResearch.com Interview with:
Daniel Chasman, PhD

Pamela Rist, ScD,
Yanjun Guo, MD, PhD
Division of Preventative Medicine
Brigham and Women’s Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been speculation in the field about relationships between coagulation and migraine susceptibility for some time, but previous research has been largely inconclusive. In this study, we leveraged Mendelian randomization, a mode of genetic analysis that can support or refute potential causal effects on a health outcome, to examine whether hemostatic factors may contribute to risk of MA.

MedicalResearch.com: What are the main findings? Could these findings change treatment strategies? 

Response: We found a strong association between four coagulation factors and migraine susceptibility. We observed that genetically increased levels of three blood clotting factors: coagulation factor VIII, von Willebrand factor, and phosphorylated fibrinopeptide A, and genetically decreased levels of fibrinogen (a protein important in the late stages of the blood clotting process) were all associated with genetically increased migraine susceptibility. Interestingly, we did not find this association among individuals who experience migraine without aura (MO), indicating a specific relationship between these hemostatic factors and migraine with aura. 

There are no updates to clinical management of migraine based on the results of this study. However, as mentioned below, the results of this study highlight the importance of examining a specific aspect of the coagulation cascade in follow-up studies. 

MedicalResearch.com: What should readers take away from your report?

Response: The main finding is support (but not proof) of a potential causal relationship between the hemostatic measures and migraine with aura, providing potential insights into mechanisms that differentiate migraine with aura (MA) from migraine without aura (MO). 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Future studies should be performed which directly measure these four coagulation factors (i.e. as opposed to using inference from genetics) to determine their association with migraine and whether they play a role in the onset of migraine attacks.

MedicalResearch.com: Is there anything else you would like to add?

Response: Funding for this work was provided by the U.S. National Institutes of Health and U.S. National Institute of Neurological Disorders and Stroke (R21NS09296 and R21NS104398), the National Heart, Lung and Blood Institute (R01HL134894, R01HL139553, and , K01 HL128791), the American Heart Association (grant 18CDA34110116), a Miguel Servet contract from the ISCIII Spanish Health Institute (CP17/00142) and co-financed by the European Social Fund. The WGHS is supported by the National Heart, Lung, and Blood Institute (HL043851 and HL080467) and the National Cancer Institute (CA047988 and UM1CA182913) with funding for genotyping provided by Amgen.

Disclosures: A co-author reports to have provided methodological expertise to Amgen and CoLucid, for which the Charité Universitätsmedizin Berlin has received financial compensation and further received honoraria from Novartis and Daiichi Sankyo for a scientific presentation and from Lilly, Newsenselab, and Total for methodological advice. The remaining authors have nothing to disclose.


Association Between Hemostatic Profile and Migraine A Mendelian Randomization Analysis

Yanjun Guo, Pamela M. Rist, Maria Sabater-Lleal, Paul de Vries, Nicholas Smith, Paul M Ridker, Tobias Kurth, Daniel I. Chasman
Neurology May 2021, 96 (20) e2481-e2487; DOI: 10.1212/WNL.0000000000011931 

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Last Updated on May 22, 2021 by Marie Benz MD FAAD