What You Need to Know About Migraine and Heart Disease

Growing evidence suggests migraine is a risk factor for heart disease. However, the increase in risk for developing heart disease is likely minimal for people with migraine, especially for groups such as young women, whose baseline stroke risk is already low.

Migraine comes with higher rates of cardiovascular disease, stroke, atrial fibrillation, metabolic syndrome, heart attack, hypertension, and dyslipidemia, says Jonathan Fialkow, MD, chief of cardiology at Baptist Health Miami Cardiac and Vascular Institute in Miami.

“The connection isn’t entirely understood, but we do have some strong theories,” says Heather Shenkman, MD, a board-certified interventional cardiologist in Tarzana, California, and 1MD Nutrition Advisory Board member.

“One big factor is the way migraine affects blood vessels,” says Dr. Shenkman. Because migraine often comes with vascular instability — meaning blood vessels can suddenly tighten or widen — the risk of clots, inflammation, and arterial damage can increase over time, she explains.

People with migraine also have higher levels of inflammatory markers, which can contribute to plaque buildup in the arteries, a major heart disease risk factor, says Shenkman.

Migraine and heart disease could also stem from the same lifestyle and genetic risk factors, says Dr. Fialkow.

A stroke is a life-threatening condition that occurs when blood flow is cut off from the brain.

Researchers suggest this connection could have to do with genetic mutations that affect brain pathways involved with both migraine and stroke, as well as hormone fluctuations, especially involving estrogen.

If you experience any new aura symptoms, especially visual symptoms, numbness, or weakness, it’s important to seek prompt medical evaluation to rule out serious medical events like stroke.

PFO closure isn’t necessarily more effective than other medical therapies for migraine, says Fialkow. “More research is needed before definitive PFO closure for migraine relief can be offered,” he says. For now, migraine patients should not be having their PFO closed unless they have a stroke that's likely to be from the PFO's contribution.

“The link between the two likely comes down to autonomic dysfunction, meaning the nervous system isn’t regulating blood vessel tone properly,” says Shenkman. “In POTS, blood pools in the lower extremities when standing, causing reduced blood flow to the brian. Because the brain is sensitive to changes in blood flow, this could cause migraine attacks.”

• Beta-blockers can lower blood pressure and prevent migraine attacks, so these medications are safer for people with a high heart disease risk profile.
• Topiramate is a seizure prevention medication that can also prevent migraine attacks. While effective, it may have a higher rate of side effects.
• Statins, a cholesterol-lowering class of medication, show promise in preventing migraine attacks, but more research is needed to confirm this.

The overall lifetime risk of heart disease is still low for most people with migraine, but it’s a sign to take extra steps to care for your heart, says Shenkman.

It’s a good idea to talk with your doctor about headaches and estrogen-based birth control or hormone therapy to evaluate how these could impact your own stroke risk, especially if you’re a woman over age 35 and have migraine with aura.

You might also explore nonhormonal or estrogen-free alternatives to hormonal contraceptives and hormone replacement therapy, like an IUD or antidepressants.

• Maintain a healthy blood pressure by lowering stress and reducing sodium.
• Manage your cholesterol.
• Get at least 150 minutes of moderate intensity exercise per week.
• Avoid smoking and alcohol.
• Consider alternatives to estrogen-based contraceptives or hormone therapies.
• Keep up-to-date with any cardiovascular screening your doctor recommends.

“Heart health and migraine management go hand in hand,” says Shenkman. Many of the actions you can take to lower your risk of heart disease may also help prevent migraine attacks, she says.

The Takeaway

• Migraine, especially with aura, is a risk factor for many types of heart disease, including ischemic stroke.
• For groups like young women whose baseline risk of stroke is low, having migraine doesn’t raise your overall heart disease risk much.
• If you experience migraine with aura and have concerns about medications and your overall heart disease risk, talk with your doctor for guidance tailored to your individual health profile.