The Link Between Migraines and Cardiovascular Disease

Research has already established that having migraine, especially migraine with aura, increases your risk of ischemic stroke, the most common type of stroke. Now scientists are finding that if you have migraines, you may also be at an increased risk of developing cardiovascular disease.

What the Research Shows

Since migraine has been consistently associated with a higher risk of stroke, studies have been looking at how this risk applies to other types of cardiovascular disease as well, such as:

• Heart attack
• Hemorrhagic stroke
• Heart arrhythmias (abnormal heart rate)
• Transient ischemic attacks (TIAs, also known as mini-strokes)
• Angina (chest pain caused by decreased blood flow to your heart)
• Venous thromboembolism

In a 2016 study, 115,541 people assigned female at birth were followed for more than 20 years, with 17,531 of the participants reporting a migraine diagnosis. The study found that those with migraines had a 50 percent higher risk of developing cardiovascular disease, particularly heart attack, stroke, or angina. Although the overall risk is still small, it's significant when looking specifically at the population of migraineurs assigned female at birth.

A similar 2018 Danish population study compared 51,032 people with migraine to 510,320 in the general population without, none of whom had any previous history of cardiovascular events. The researchers found that migraine is associated with a higher risk of specific manifestations of cardiovascular disease, including both ischemic and hemorrhagic stroke, heart attack, and venous thromboembolism, in all study participants regardless of sex assigned at birth.

These associations were even stronger in study participants assigned female at birth than in participants assigned male at birth, in people who had migraine with aura than those without, and during the first year after being diagnosed with migraine, though they persisted into the long term as well.

The researchers also found something that's new to the conversation—an association between migraine and a heart arrhythmia called atrial fibrillation.

Theories About the Connection

Scientists are still scratching their heads about why this link exists, as the connection is likely complex. Here are some of the current theories on the underlying mechanisms migraine and cardiovascular disease may share.

Vascular Vulnerability

One theory is that the blood vessels of migraineurs may have some sort of vulnerability that influences both the development of migraine and cardiovascular disease. Endothelial dysfunction, a condition in which the deepest layer of your small arteries (the endothelium) stops working properly, is associated with both cardiovascular disease and migraine, so it's possible that it plays a part in vascular vulnerability.

Inflammation

Inflammation may also play a role in this connection. In fact, in one 2015 study, the combination of a statin and vitamin D (which may have anti-inflammatory effects) were found to prevent migraines—and it's already known that statins benefit your cardiovascular risk by lowering cholesterol.

Hormones

Because estrogen is so closely associated with both migraine and cardiovascular disease, it may also explain the connection between the two conditions, as well as why people assigned female at birth are at higher risk.

Cardiovascular Risk Factors

Migraineurs seem to have a higher number of cardiovascular risk factors, which may play a role as well. For instance, in the aforementioned 2016 study, compared to the people assigned female at birth without migraines, the migraineurs were more likely to have characteristics that put someone at a higher risk of having a heart attack or stroke, including:

• High blood pressure (hypertension)
• High cholesterol levels
• Current smokers
• A family history of heart attacks
• Being overweight

Another study, published in 2018, looked at the association between migraine and hypertension in 29,040 study participants assigned female at birth who didn't have high blood pressure. After an average follow-up time of 12.2 years later, the researchers found that, compared to those who had no history of migraine, those who had any history of migraine had a higher risk of developing hypertension. Specifically, they found that:

• People assigned female at birth who had migraine with aura had a 9 percent higher risk.
• People assigned female at birth with migraine without aura had a 21 percent higher risk.
• Those with any past history of migraine had a 15 percent higher risk.

Since we know high blood pressure is a risk factor for cardiovascular disease, this study's findings may be another explanation for the relationship between migraine and cardiovascular disease.

Genetics

Shared genetic markers that increase the vulnerability for both migraine and cardiovascular disease are another theory behind the connection.

What This Means for You

There isn't yet any evidence to confirm whether preventing migraines may lower the risk of developing cardiovascular disease. It's only known that migraines seem to pose additional cardiovascular risk, especially for people assigned female at birth.

This cardiovascular risk is especially a concern for this population as they get older because the risk for cardiovascular disease increases as they approach midlife and menopause. This is a result of the natural aging process and probably the decline in estrogen that as ovaries fail and they stop menstruating.

If you have migraines, there aren't currently any guidelines suggesting that a healthcare provider should implement heart and stroke preventive measures, such as aspirin therapy, based on the presence of migraines alone. There is also no scientific data supporting the use of a migraine preventive medication in preventing another stroke in a migraineur with a history of stroke. 

However, if you have migraines, it doesn't hurt to ask a healthcare provider to check for and review with you other cardiovascular risk factors—like a history of smoking, use of oral contraceptives, high blood pressure, high cholesterol, or a family history of heart attacks or strokes— which should be done for everyone anyway.

A Word From Verywell

Cardiovascular disease is a leading concern, especially for people assigned female at birth as they approach midlife, whether or not you have migraines. However, having migraines may pose an additional risk. What is causing the link between migraines and cardiovascular disease needs to be determined by future scientific studies. In the meantime, take steps to be good to your brain, heart, and blood vessels by maintaining a normal weight, quitting smoking, eating a healthy diet, and exercising regularly.