An estimated 15% of people in the U.S. suffers from migraine and severe headache - with prevalence rates twice as high in women as in men. Research reveals a consistent association between migraine headache and cardiovascular disease.

People often feel nauseated and are sensitive to light and sound during a migraine. And up to a third of sufferers experience strange visual or physical sensations known as an aura.

Usually, the aura occurs shortly before the headache, although some people experience the aura without a headache. Both versions are known as aura migraine or classic migraine. And both of them have long been linked to an increased risk of cardiovascular disease, particularly stroke. 

In a population-based cohort study published in BMJ in 2018, researchers studied the risk of numerous cardiovascular diseases in 51,032 patients with migraine relative to 510,320 people in the general population over a 19-year period. Migraine has been found to be strongly correlated with ischemic stroke, hemorrhagic stroke, venous thromboembolism, myocardial infarction and atrial fibrillation or atrial flutter.

The link between migraine and stroke was particularly pronounced in women who had been diagnosed with aura migraine in the previous 12 months. Other findings also affirm this association between migraine and cardiovascular disease in women, most commonly in those with aura migraine as well as those who were younger than 45 years of age, smoked cigarettes or took oral contraceptives.

Despite consistent data highlighting the association between migraine and cardiovascular disease, a survey of 80 physicians found that more than one-third of responding neurologists and cardiologists were unaware that migraine is a risk factor for cardiovascular disease relative to more than 85% of obstetricians/gynecologists - possibly owing to the high prevalence of migraine in women of childbearing age.

Such findings indicate that "academic curriculum needs to include [migraine] as a cardiovascular disease risk factor to improve physician awareness and improve overall cardiovascular disease risk assessment," wrote the authors of a review published in Trends in Cardiovascular Medicine. "Evaluation of [migraine], especially migraine with aura, should be implemented into the risk stratification of cardiovascular disease for women during primary care, neurology and cardiology evaluations."

The pathophysiology of migraine and its connection with cardiovascular disease needs to be thoroughly established and studies should focus on genetic and biochemical processes as well as the prevention of migraine and cardiovascular disease. Education regarding these risk factors and the relation between migraine and cardiovascular disease are relevant not only for patients but also for clinicians.