Migraine Headache: An Under‐Appreciated Risk Factor for Cardiovascular Disease in Women

M igraine headache is a common, chronic disorder, and women comprise two thirds of patients with this disorder, that has negative effects on health and is costly for patients and society. There is accumulating evidence linking migraine, particularly with aura, to increased risk for cardiovascular events. Given the high prevalence of this condition and the fact it affects younger women, it is important to educate cardiovascular disease (CVD) providers about the potential increased cardiovascular risk associated with migraine. In this review, an overview is provided of epidemiological studies linking migraine headache and cardiovascular events, with emphasis on women, and the possible pathophysiological mechanisms for this association. However, there are many important knowledge gaps on the sex-related aspects of migraine that potentially impact advances in management. An additional purpose of this document is to summarize these areas and provide recommendations to address these gaps. Briefly, migraine (ie, episodic migraine) is characterized by moderate to severe headache, with or without transient focal neurology symptoms (eg, aura) that persists 4 to 72 hours. Approximately 1 in 3 patients with migraine experience aura, which may be visual (eg, lights), auditory (eg, noises), somatosensory (eg, tingling and numbness), or motor (eg, jerking movements). Typically, aura precedes the onset of headache and persists for less than an hour. There is variation in the number of attacks between patients: some experience multiple attacks weekly while others experience <1 per year. There is also wide variation in the frequency of episodes within the same individual, and often the condition improves with advancing age. Patients who experience several attacks monthly (ie, ≥15 headache days a month) are classified as having chronic migraine. Worldwide, migraine is the third most prevalent medical condition and second most disabling neurological disorder. In the United States, its annual prevalence is 1 in 8 adults. Migraine usually affects youngto middle-aged women (25–55 years old). Although the prevalence of migraine is generally low before puberty ( 2.5%) and is similar in boys and girls, the prevalence increases in girls at about 10 years of age versus boys. The prevalence continues to rise in women versus men (18% versus 6%), peaking at about 30 years old. The prevalence decreases after age 42 years in both sexes, but remains 2 times higher in women.