Migraine with Aura Significantly Linked to Incident Atrial Fibrillation

Souvik Sen, MD, MS, MPH

Migraine with aura was associated with an increased risk of incident atrial fibrillation, according to a new study.

Investigators from the University of South Carolina School of Medicine recently conducted a longitudinal study of patients with migraine history enrolled between 1993 and 1995, and followed for incident atrial fibrillation through 2013. They assessed nearly 12,000 patients for headache without prior atrial fibrillation or stroke; of those, 426 patients reported migraines with visual aura and 1090 had migraines without visual aura.

An additional 1018 reported nonmigraine headache and the other 9,405 patients reported no headache. This research was part of the Atherosclerosis Risk in Communities (ARIC) study, examining cardioembolic stroke risk.

The investigators studied the relationship between migraine and its subtypes with incident atrial fibrillation and compared that to the controls without the headaches. The team also collected data about age, sex, race, vascular risk factors including hypertension, body mass index, waist-to-hip ratio, and lipid profile.

The investigators also chose an age cutoff of 60 years, as prior reports from the larger ARIC study as a whole showed a 1.5 to 2.0 times greater increase of incident atrial fibrillation in those older patients compared to younger patients. The team, led by author Souvik Sen, MD, MS, MPH, found that the non-headache group was significantly older compared with the migraine headache groups (60.4 years vs. 58.4 years, respectively).

They also learned that the non-headache group had a higher proportion of men, African American individuals, diabetics, smokers, alcohol users, and those with coronary artery disease compared to the migraine headache group.

The migraine group had a higher proportion of hypercholesterolemia and higher levels of total cholesterol compared to the no-headache group. BMI was also higher in the non-headache group compared to the migraine group.

Migraine with visual aura was associated risk of atrial fibrillation compared to no headache, as well as compared to migraine without visual aura, the investigators learned.

“The surprising observation is that we have known that migraine with aura is a stroke risk factor,” study author Souvik Sen, MD, MS, MPH told MD Magazine®. “We also know that atrial fibrillation is a common cause for stroke. We were able to find a significant link between the two and potential that atrial fibrillation may be the mediator of the migraine with aura-stroke risk.”

The study authors also said that several case reports have reported incidence of atrial fibrillation during a migraine attack, as autonomic dysfunction has a role in the pathophysiology of both migraine and atrial fibrillation, they wrote.

“The implication is that as migraine with aura patients’ age the primary care physicians may have to be vigilant about atrial fibrillation,” Sen added. “Once detected they may apply existing risk scores such as CHADS2Vasc to determine whether to place patient on aspirin or oral anticoagulant, to reduce the stroke risk.”

The investigators believe their findings have important clinical implications and “may help us better understand the atrial fibrillation medication of the migraine-stroke link.”

They also suggested that randomized clinical trials in the future will help determine whether migraine patients and visual auras would benefit from atrial fibrillation detection and even anticoagulation or antiplatelet therapies as a primary stroke prevention strategy.

The study, “Migraine with visual aura is a risk factor for incident atrial fibrillation,” was published online in Neurology.