Migraine With Aura Associated With Increased Risk of Atrial Fibrillation

Migraine with aura has previously been linked to an increased risk of ischemic stroke compared with no migraine. Specifically, the migraine subtype is associated with an increased risk of cardioembolic stroke. Now, researchers have demonstrated that migraine with aura is associated with an increased risk of atrial fibrillation (AF), which may help provide a clearer picture of the relationship between migraine with aura and cardioembolic stroke, as AF is a common source of cardioembolic stroke.

According to researchers, the study of 11,939 patients with migraine found that stroke incidence rate was approximately twice as prevalent among patients with migraine with aura compared to those with migraine without aura.

During the longitudinal, community-based Atherosclerosis Risk in Communities Study, participants were interviewed for migraine history in 1993-1995 and were followed for incident AF through 2013. A total of 426 patients had migraine with aura, 1090 had migraine without aura, 1018 had nonmigraine headache, and 9405 had no headache.

Patients without headache were significantly older than those with migraine (60.4 versus 58.4 years) and had a significantly higher proportion of men, African Americans, those with diabetes, smokers, alcohol users, and those with coronary artery disease. Meanwhile, the patients with migraine had a higher proportion of hypercholesterolemia and higher levels of total cholesterol.

Over the 20-year follow-up period, incident AF was observed in 232 (15%) of 1516 patients with migraine and in 1623 (17%) of 9405 patients without headache, resulting in a crude incidence rate of AF of 7.7/1000 person-years in the migraine cohort and 8.6/1000 person-years in the nonheadache group.

According to the researchers, the higher stroke incidence among patients without migraine can be explained by the significant differences noted in the baseline characteristics. “Most important, the no-headache participants were older, males, smokers, and those with coronary artery disease, and hence may be at cardiovascular risk predisposing them to AF,” noted the researchers.

Among the migraine group, incident AF was observed in 80 (18%) of 440 patients with migraine with aura and in 152 (14%) of 1105 patients with migraine without aura over the 20-year period, resulting in a crude incidence rate of 9.1/1000 person-years in the migraine with aura group and 6.9/1000 person-years in the migraine without aura group.

Following adjustment for age, sex, race, hypertension, diabetes, hypercholesterolemia, smoking, coronary artery disease, and congestive heart failure, only migraine with aura was associated with a significantly higher risk of incident AF (HR 1.30, 95% CI 1.03-1.62).

Reference:

Sen S, Androulakis M, Duda V, et al. Migraine with visual aura a risk factor for incident atrial fibrillation. [published online November 14,2018]. Neurology. doi: 10.1212/WNL.0000000000006650.