Some people who suffer from these intense, throbbing headaches may be at increased risk of stroke or heart attack.
Approximately 1 in 6 adults in the United States reports having a migraine, but this debilitating headache is three times more common in women. During a migraine attack, people often feel nauseous and become sensitive to light and sound. And up to a third of migraine sufferers experience strange visual or physical sensations known as auras (see What are migraine auras?).
Auras usually occur just before a headache, but some people experience just the aura without a headache. Both versions are known as migraine with aura or classic migraine. And both have long been associated with an increased risk of cardiovascular disease, particularly stroke. But migraine sufferers need to interpret this risk in context, says Dr. Christopher Anderson, director of stroke and cerebrovascular disease at Harvard Brigham and Women’s Hospital.
“Migraine headaches tend to be most common in young women, who have a very low baseline risk of stroke,” Dr. Anderson explains. The latest evidence comes from a 2020 study. Japan Automobile Manufacturers Association Approximately 28,000 women participated in the Women’s Health Study. All were over 45 years old and had no evidence of cardiovascular disease when the study began in the early 1990s. Researchers tracked the women’s health until 2018.
Only 5% of participants reported having migraine with aura. The annual incidence of heart attack, stroke, and death from cardiovascular disease (3.4 per 1,000 women) is slightly lower than the annual incidence of migraine without aura, or for women without migraine (2.1 per 1,000 women). It was expensive.
What are the signs of a migraine?A migraine aura is a visual or sensory disturbance that occurs within an hour before the onset of the headache. Vision changes often include blind spots, known as scotomas, that affect both eyes on only one side of the visual field. In people with other symptoms, scotomas usually appear black, but in migraine patients they are usually white or gray (although in rare cases they may be colored). The scotoma usually appears as a crescent-shaped, shimmering, or shimmering zigzag that spreads to one side of the visual field and eventually moves into the peripheral vision. One common variation is called the “fortress spectrum” because the pattern of bright geometric lines resembles the walls of a medieval fort. The aura may also cause a tingling sensation on one side of the body, especially the face and hands. Occasionally, people experience a speech aura that causes a temporary speech impediment, which can also occur with a stroke or mini-stroke. Very rarely, the aura can cause unilateral weakness in the legs, arms, and face. This is known as hemiplegic migraine. Again, these symptoms can also occur with a stroke or mini-stroke. |
A sharing mechanism?
Experts don’t know exactly what’s behind this observation, but one theory points to a common underlying mechanism. Migraines are thought to be caused by abnormal patterns of electrical activity in the brain, caused by sweeping waves of neurons firing and then extinguishing. Migraine aura may be a manifestation of this phenomenon, which doctors call cortical spreading depression. “This may reflect some kind of vascular instability, which may make people more susceptible to cardiovascular disease,” Dr. Anderson says.
If you experience a migraine with aura, there are no specific steps you can take to limit your cardiovascular risk. However, if you are a woman over 35 and have migraines with aura, you should definitely tell your doctor or gynecologist about your headaches. Taking estrogen-containing oral contraceptives and hormonal therapy may further increase the risk of stroke in these women. As a result, other non-hormonal or estrogen-free treatment options may need to be considered. “We don’t necessarily want to discourage women from taking hormones, because the risk-benefit calculation is different for everyone,” Dr. Anderson says. “Make sure all your doctors are aware of your health status and all of your current medications,” he advises.
Don’t ignore new symptoms
Auras do not occur before every migraine, but once they do, you are considered to have a classic migraine. However, in adulthood, new symptoms usually do not appear between future migraines. Most people seem to have their own predictable version of headaches. So if new symptoms appear, don’t ignore them, says Dr. Anderson. For example, if a typical aura consists of flashes of light, but you start to feel numbness or weakness in your hands, he warns, it could be something other than a migraine. Seek emergency treatment as soon as possible.
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