Cardiovascular risk factors and migraine: Results from the population-based Rotterdam study

Abstract text (incl. figure legends and references)

Objective Migraine is associated with cardiovascular (CV) events. Interestingly, less is known about the link between CV risk factors and migraine, and the role of sex herein. Therefore, we conducted this study to investigate the association between the lifetime prevalence of migraine and CV risk factors in both sexes.

Methods In 7266 participants from the population-based Rotterdam Study (median age 66.6 [IQR 56.4−74.8], 57.5% female), we assessed migraine using a structured interview. Migraine patients were matched by age to individuals without migraine (ratio 1:3). We performed univariable and multivariable conditional logistic regression analyses on the association of CV risk factors and migraine, stratified for sex. In the first model we included clinical risk factors: current smoking, obesity, hypercholesterolemia, hypertension, and diabetes mellitus (DM). The second model aimed to provide insights into the contribution of separate components of the CV system, including smoking status (former/current), total cholesterol, high-density lipoprotein, triglycerides, systolic and diastolic blood pressure (BP), body mass index, and DM. Both models were additionally adjusted for alcohol intake and physical activity.

Results From the 7266, 1085 had active or a history of migraine. We found that current smoking was related to a lower migraine prevalence in females (Odds Ratio (OR) 0.72, 95% CI 0.58-0.90). Also, a higher diastolic BP related to a slightly higher prevalence of migraine in females only (OR 1.11, 95% CI 1.02-1.20). No associations were observed for other factors in both sexes.

Conclusions Traditional CV risk factors are unrelated to migraine, except for smoking. While underlying mechanisms are not clarified yet, our study contributes to the hypothesis that migraine is associated with non-traditional CV risk factors, which may relate to microvascular dysfunction, as reflected by the slightly increased diastolic BP. These mechanisms may differ among sexes.