A condition called migraine with aura is characterized by a severe headache lasting at least four hours often preceded by vision problems, such as flashes of light, blind spots, and distorted sight. People who experience this type of migraine may be at a higher risk of an irregular heartbeat, known as atrial fibrillation (Afib), according to a study published online in Neurology on November 14.
To test the association between migraine with aura and Afib, a team of researchers studied data from the Atherosclerosis Risk in Community (ARIC) study, a longitudinal study initiated in 1987 to analyze atherosclerosis causes and clinical outcomes. From 1993 to 1995, ARIC participants were interviewed for migraine history and followed for Afib through 2013.
The researchers assessed 11,939 participants without prior Afib or stroke with an average age of 60 years at the end of follow-up. Fifty-six percent were women and 77 percent were white.
They asked participants to complete a headache questionnaire to identify those with and without migraine with aura. Based on the questionnaire, 426 people had migraine with visual aura, 1,090 had migraine without visual aura, 1,018 had non-migraine headaches; and 9,405 had no headaches. Those in the no-headache group were older than in the migraine group (average age 60.4 years vs 58.4 years) and consisted of more men, African Americans, people with diabetes, smokers, alcohol users, and people with coronary artery disease.
Meanwhile, the migraine group had more participants with hypercholesterolemia and higher levels of total cholesterol compared to the no-headache group.
The researchers diagnosed participants with Afib based on electrocardiographic findings, hospital discharge codes, and death certificates. They diagnosed participants with stroke based on computers and a physician medical-record review; any differences were settled by a physician reviewer.
During the follow-up period, 15.3 percent of participants with migraine and 17.3 percent of participants with no headaches experienced Afib.
After adjusting for age, sex, race, hypertension, diabetes, smoking, hypercholesterolemia, coronary artery disease, and congestive heart failure, the researchers noted that people with migraine with visual aura had a 30 percent increased risk of developing Afib compared to the no-headache group, and a 39 percent increased risk compared to those with migraine with no aura.
The researchers noted that of the 167 patients who experienced strokes, 87 percent had been diagnosed with Afib before the stroke. Overall, the findings suggested Afib influenced the higher risk of stroke in patients with migraine with visual aura.
The researchers believe their study represents the first report of a link between migraine and Afib in the United States. They also hypothesized that the link may be related to a dysfunctional autonomic nervous system, which can affect various functions such as heart rate and blood pressure. In conclusion, they emphasized that a randomized clinical trial may help determine whether patients with migraine with visual aura would benefit from Afib detection and primary stroke prevention.
