Migraine and the risk of cardiovascular and cerebrovascular events: A meta-analysis of 16 cohort studies including 1 152 407 subjects

Ahmed N. Mahmoud, Amgad Mentias, Akram Y. Elgendy, Abdul Qazi, Amr F. Barakat, Marwan Saad, Ala Mohsen, Ahmed Abuzaid, Hend Mansoor, Mohammad K. Mojadidi, Islam Y. Elgendy

Research output: Contribution to journalArticlepeer-review

184 Scopus citations

Abstract

Objectives To perform an updated meta-analysis to evaluate the long-term cardiovascular and cerebrovascular outcomes among migraineurs. Setting A meta-analysis of cohort studies performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources The MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials databases were searched for relevant articles. Participants A total of 16 cohort studies (18 study records) with 394 942 migraineurs and 757 465 non-migraineurs were analysed. Primary and secondary outcome measures Major adverse cardiovascular and cerebrovascular events (MACCE), stroke (ie, ischaemic, haemorrhagic or non-specified), myocardial infarction (MI) and all-cause mortality. The outcomes were reported at the longest available follow-up. Data analysis Summary-adjusted hazard ratios (HR) were calculated by random-effects Der-Simonian and Liard model. The risk of bias was assessed by the Newcastle-Ottawa Scale. Results Migraine was associated with a higher risk of MACCE (adjusted HR 1.42, 95% confidence interval [CI] 1.26 to 1.60, P<0.001, I 2 =40%) driven by a higher risk of stroke (adjusted HR 1.41, 95% CI 1.25 to 1.61, P<0.001, I 2 =72%) and MI (adjusted HR 1.23, 95% CI 1.03 to 1.43, P=0.006, I 2 =59%). There was no difference in the risk of all-cause mortality (adjusted HR 0.93, 95% CI 0.78 to 1.10, P=0.38, I 2 =91%), with a considerable degree of statistical heterogeneity between the studies. The presence of aura was an effect modifier for stroke (adjusted HR aura 1.56, 95% CI 1.30 to 1.87 vs adjusted HR no aura 1.11, 95% CI 0.94 to 1.31, P interaction =0.01) and all-cause mortality (adjusted HR aura 1.20, 95% CI 1.12 to 1.30 vs adjusted HR no aura 0.96, 95% CI 0.86 to 1.07, P interaction <0.001). Conclusion Migraine headache was associated with an increased long-term risk of cardiovascular and cerebrovascular events. This effect was due to an increased risk of stroke (both ischaemic and haemorrhagic) and MI. There was a moderate to severe degree of heterogeneity for the outcomes, which was partly explained by the presence of aura.

Original languageEnglish
Article numbere020498
JournalBMJ Open
Volume8
Issue number3
DOIs
StatePublished - Mar 1 2018

Bibliographical note

Publisher Copyright:
© 2018 Article author(s).

Keywords

  • cardiac epidemiology
  • migraine
  • myocardial infarction
  • stroke

ASJC Scopus subject areas

  • General Medicine

Fingerprint

Dive into the research topics of 'Migraine and the risk of cardiovascular and cerebrovascular events: A meta-analysis of 16 cohort studies including 1 152 407 subjects'. Together they form a unique fingerprint.

Cite this