Research Report on Gender-Specific Association Between Cardiovascular Risk Factors and Migraine

Academic Background

Migraine is a common neurological disorder. Previous studies have shown that migraine, especially migraine with aura, is associated with cardiovascular events such as myocardial infarction, coronary heart disease, and cardiovascular mortality. However, current research on the relationship between cardiovascular risk factors (CVRFs) and migraine is insufficient. This knowledge is clinically significant as it can provide directions for reducing cardiovascular risks in migraine patients.

The main objective of this study is to explore the gender-specific association between cardiovascular risk factors (such as smoking, obesity, hypercholesterolemia, hypertension, and diabetes) and the lifetime prevalence of migraine. The study hypothesizes that these cardiovascular risk factors are associated with a higher prevalence of migraine.

Research Source

This academic paper was co-authored by Linda Al-Hassany, MSc, Cevdet Acarsoy, MSc, M. Kamran Ikram, MD, PhD, Daniel Bos, MD, PhD, and Antoinette Maassenvandenbrink, PhD, from the Division of Vascular Medicine and Pharmacology, Departments of Epidemiology, Neurology, and Radiology and Nuclear Medicine at Erasmus Medical Center. The paper was published in the journal Neurology®, Volume 103, Issue 4, in 2024.

Research Design

Subjects and Methods

This study was conducted in a prospective, population-based cohort study (Rotterdam Study) in Rotterdam, Netherlands, targeting middle-aged and elderly residents. The study included 7266 middle-aged and elderly community residents, primarily collecting data on lifetime migraine prevalence and cardiovascular risk factors through structured interviews, physical examinations, and blood sampling.

Migraine Diagnosis Assessment

Migraine diagnosis was assessed through a structured migraine questionnaire based on the second edition of the International Classification of Headache Disorders (ICHD-II) diagnostic criteria. The study included participants with existing migraine assessment data from three population cohorts in the Rotterdam Study.

Cardiovascular Risk Factors Assessment

Cardiovascular risk factors included current smoking, obesity, hypercholesterolemia, hypertension, and diabetes. Data were collected through interviews, including smoking status, alcohol consumption, physical activity, and medication use. Cardiovascular and metabolic risk factors were obtained through physical examinations and blood tests.

Data Analysis

Age matching (1:3) was performed to adjust for the confounding effect of age. Conditional logistic regression analysis was used to explore the gender-stratified association between different cardiovascular risk factors and migraine. Multiple imputation was used to fill in missing data, and multiple statistical models were applied to analyze the association of these risk factors with lifetime migraine prevalence.

Research Results

Main Findings

Among the 7266 study participants, 1085 (14.9%) met the diagnostic criteria for migraine. Results showed that in women, current smoking (OR 0.72, 95% CI 0.58–0.90), more pack-years of smoking (OR per SD increase 0.91, 95% CI 0.84–1.00), diabetes (OR 0.74, 95% CI 0.56–0.98), and higher fasting glucose levels (OR per SD increase in glucose 0.90, 95% CI 0.82–0.98) were associated with a lower prevalence of migraine; while higher diastolic blood pressure was associated with a higher prevalence of migraine (OR per SD increase 1.16, 95% CI 1.04–1.29). In men, no significant association was found between cardiovascular risk factors and migraine.

Results Logical Analysis

The study results suggest that traditional cardiovascular risk factors are not directly associated with a higher prevalence of migraine in middle-aged and elderly populations. This finding supports the hypothesis that migraine may not be directly influenced by traditional cardiovascular risk factors, and future studies should further validate these findings and extend to younger populations.

Research Significance

Scientific and Practical Value

This study provides new insights into the relationship between migraine and cardiovascular disease, especially considering the potential regulatory role of gender. These findings help to reveal the potential mechanisms linking migraine and cardiovascular risk and may lead to the development of preventive strategies to reduce overall cardiovascular risk.

Research Highlights

• Important Findings: The study identified gender-specific associations between certain cardiovascular risk factors and migraine prevalence. In women, certain cardiovascular risk factors (such as smoking, diabetes, and high glucose levels) were associated with a lower prevalence of migraine, while higher diastolic blood pressure was associated with a higher prevalence of migraine.
• Innovative Research Methods: The study used comprehensive cohort analysis methods, combining age matching and multi-model adjustments, ensuring the accuracy and reliability of data analysis.
• Specificity of Study Subjects: The study subjects were middle-aged and elderly community residents, helping to understand the relationship between migraine and cardiovascular risk factors in this age group.

Conclusion and Outlook

Although the relationship between migraine and cardiovascular events is established, this study found that most traditional cardiovascular risk factors were not associated with an increased prevalence of migraine in middle-aged and elderly populations. Instead, diabetes, high glucose, and smoking in women were associated with a lower prevalence of migraine, while higher diastolic blood pressure was associated with an increased prevalence of migraine. These results suggest that the association between migraine and cardiovascular disease may not be through traditional risk factors but may involve microvascular dysfunction.

Future translational research is needed to validate these hypotheses, explore specific mechanisms linking migraine and cardiovascular disease, especially among younger populations and across different age groups. Future studies should also consider other unexplored cardiovascular risk factors such as microemboli, patent foramen ovale, vascular spasms, fibromuscular dysplasia, arterial dissection, and atrial fibrillation.