Migraine is a genetic neurological disease that affects about 36 million people in the United States. It effects women at a rate of 3-4 times higher than men, this equals to about 1 in 5 women who have migraine. There are two main subtypes of migraine; mainly migraine without aura and migraine with aura. In women who have migraine with aura, people notice that along with the headache, they will have other neurological symptoms. These can include seeing lights or stars in one field of their vision, a blind spot that can grow, or numbness and weakness on one side of his/her body. This can happen even before the onset of the headache or during the time of their headache. It can also occur without the headache.
Studies have shown that in addition to these neurological symptoms in a migraine, women with migraine with aura can be at risk of other medical conditions as well. Large population studies have confirmed that women with migraine with aura do have about a two time increase risk of stroke. This risk has only been seen in women who have the subtype of migraine with aura. This risk is seen mainly in women who are between the ages of 18-45, and the risk seems to decrease after menopause in women. This risk of stroke is increased in women who have migraine with aura, who also smoke and have other stroke risk factors, like hypertension. There is also some evidence that the risk can be increased if women are also using exogenous hormones, as in hormonal contraception.
There are also studies that show that the risk for other cardiovascular diseases are also increased in women with migraine with aura. There is an increased risk of myocardial infarction and angina. Again, the risk is worsened if there are other risk factors in these women.
Although the number may seem scary, there is also overall good news. The absolute numbers for stroke in women with migraine with aura is low, since stroke in this otherwise young, healthy population is extremely low. In women where strokes have occurred, they are usually small with little focal deficits. However, the goal is to overall avoid a stroke. It is also important to be aware of possible stroke symptoms and call 911 immediately if they occur.
There are also steps that someone can take to lower their risk of stroke. For women who have migraine, it is important to speak with a doctor about medications to decrease the number of migraines. It is also important to make sure that other risk factors are also well controlled, especially if someone also has high blood pressure or other medical conditions like diabetes. It is also very important to stop smoking if you are. An overall healthy lifestyle with exercise and healthy foods can also make a difference in lowering risk of stroke. If a woman with migraine with aura is on or is thinking of using hormonal contraceptives, it is important to speak with a physician, including a headache specialist or gynecologist.
References:
- E, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343-9.
- Schürks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009;339:b3914.
- Bousser MG, Conard J, Kittner S, et al. Recommendations on the risk of ischaemic stroke associated with use of combined oral contraceptives and hormone replacement therapy in women with migraine. The International Headache Society Task Force on Combined Oral Contraceptives & Hormone Replacement Therapy. Cephalalgia. 2000;20(3):155-6.
- Petitti DB, Sidney S, Bernstein A, Wolf S, Quesenberry C, Ziel HK. Stroke in users of low-dose oral contraceptives. N Engl J Med. 1996;335(1):8-15.
- Sacco S, Ricci S, Carolei A. Migraine and vascular diseases: a review of the evidence and potential implications for management. Cephalalgia. 2012;32(10):785-95.
- Macgregor EA. Migraine and use of combined hormonal contraceptives: a clinical review. J Fam Plann Reprod Health Care. 2007;33(3):159-69.
- Kurth T, Rohmann KL, Shapiro RE. Migraine and risk of cardiovascular disease. BMJ 2018;360:k275
Short Article Review
- Women with headaches should speak with a doctor to gain an accurate diagnosis
- Speak with your doctor if you have other neurological symptoms with your headaches
- Be aware of your risk factors for stroke, especially if you have migraine with aura
- Learn healthy lifestyle modifications to help decrease risk of stroke
- Stop smoking if you do!
The information in this article is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your healthcare provider regarding any questions you may have about any medical condition.
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