Migraine increases risk for irregular heartbeat
“Since [atrial fibrillation] is a common source of cardioembolic stroke, the question that begs to be answered is whether the association between migraine with visual aura and cardioembolic stroke may be explained by a higher rate of atrial fibrillation in this subgroup of [a Danish, nationwide, population-based] cohort,” Souvik Sen, MD, MS, MPH, neurology department chair at the University of South Carolina, School of Medicine and colleagues wrote.
Researchers analyzed ECGs, discharge codes and death certificate data from 11,939 participants of the Atherosclerosis Risk in Communities study who did not have a prior history of stroke or atrial fibrillation.
They found that over a 20-year follow-up period, 426 patients reported migraines with visual aura, 1,018 reported nonmigraine headache, 1,090 reported migraine without visual aura and 9,405 reported no headache. Incident atrial fibrillation was noted in 15% of patients with migraine and 17% of patients without headache. After adjusting for age, coronary artery disease, congestive heart failure, current alcohol use, diabetes, fasting lipid profile, hypercholesterolemia, hypertension, race, sex and smoking status, migraine with visual aura was associated with increased risk for atrial fibrillation vs. no headache (HR = 1.3; 95% CI, 1.03-1.62) and when compared to migraine without visual aura (HR = 1.39; 95% CI, 1.05-1.83).
“We believe this may be one of the first reports of migraine-[atrial fibrillation] association from the United States,” Sen and colleagues wrote.
“This finding has important clinical implications and may help us better understand the atrial fibrillation mediation of the migraine-stroke link. A randomized clinical trial may help ascertain whether patients with migraine with visual aura may benefit from atrial fibrillation detection and subsequent anticoagulation or antiplatelet therapy as a primary stroke prevention strategy,” they added.
In a related editorial, Sebastian Fridman, MD, MPH, and Luciano A. Sposato, MD, MBA, FRCPC, of the department of clinical neurological sciences at Western University in London, Ontario, Canada, called Sen and colleagues’ findings “intriguing.”
“The investigators suggest that migraines precede atrial fibrillation and that the latter is the culprit of the higher risk of cardioembolic stroke in patients with [migraine with visual aura]. While perhaps the most reasonable hypothesis and well discussed by the authors, other possibilities warrant consideration,” they wrote.
“Fully adjusting for multiple variables rendered the mediation analysis results less robust, raising alternative explanations for how migraine with visual aura, atrial fibrillation, and ischemic stroke interact pathophysiologically. In fact, this fundamental ‘what-if’ has the potential to change how we understand the clinical meaning and the prognostic implications of migraine with visual aura,” Fridman and Sposato added. – by Janel Miller
Disclosures: Sen reports funding by NIH grants NS062754 and MD009738. Fridman reports no relevant financial disclosures. Please see the study and editorial for all other relevant financial disclosures.