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Published on: June 2, 2014
Risk for ischemic stroke and coronary heart disease associated with migraine and migraine medication among older
Emily C McKinley1, Christine L Lay2, Robert S Rosenson3
1Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA. emckinley@uabmc.edu.
Insights
Older adults with migraine face a higher risk of ischemic stroke. Migraine medication, such as triptans, may influence cardiovascular disease event risk in this population.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Migraine is linked to cardiovascular disease (CVD) in middle-aged adults.
- This study investigates CVD event risks in older adults with migraine.
Purpose of the Study:
- To determine the risk of ischemic stroke and coronary heart disease (CHD) events in older adults with migraine compared to those without.
- To explore how migraine medication affects these risks.
Main Methods:
- Retrospective cohort study of US adults aged 66+ with Medicare (2008-2017).
- Matched patients with and without migraine history (1:4 ratio).
- Follow-up for ischemic stroke and CHD events (myocardial infarction, coronary revascularization).
Main Results:
- Older adults with migraine showed increased risk for ischemic stroke (HR 1.20-1.27) and similar risk for CHD events (HR 1.02-0.99).
- Opioid use in migraine patients correlated with higher ischemic stroke risk.
- Triptan use in migraine patients correlated with lower CHD event risk.
Conclusions:
- Older adults with migraine have an elevated risk of ischemic stroke.
- Migraine medication classes may modify the risk of ischemic stroke and CHD events.
Background:
Migraine has been associated with cardiovascular disease (CVD) events among middle-aged adults. The objective of this study was to determine the risk for ischemic stroke and coronary heart disease (CHD) events among older adults with versus without migraine.
Methods:
This retrospective cohort study was conducted using data from US adults ≥66 years of age with Medicare health insurance between 2008 and 2017. After stratification by history of CVD, patients with a history of migraine were matched 1:4 to those without a history of migraine, based on calendar year, age, and sex. Patients were followed through December 31, 2017 for ischemic stroke and CHD events including myocardial infarction or coronary revascularization. All analyses were done separately for patients with and without a history of CVD.
Results:
Among patients without a history of CVD (n = 109,950 including n = 21,990 with migraine and n = 87,960 without migraine), 1789 had an ischemic stroke and 3552 had a CHD event. The adjusted hazard ratio (HR) among patients with versus without migraine was 1.20 (95% confidence interval [95%CI], 1.07-1.35) for ischemic stroke and 1.02 (95%CI, 0.93-1.11) for CHD events. Compared to patients without migraine, those with migraine who were taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.43 [95%CI, 1.20-1.69]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.79 [95%CI, 0.67-0.93]). Among patients with a history of CVD (n = 79,515 including n = 15,903 with migraine and n = 63,612 without migraine), 2960 had an ischemic stroke and 7981 had a CHD event. The adjusted HRs (95%CI) for ischemic stroke and CHD events associated with migraine were 1.27 (1.17-1.39) and 0.99 (0.93-1.05), respectively. Patients with migraine taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.21 [95%CI, 1.07-1.36]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.83 [95%CI, 0.72-0.95]), each versus those without migraine.
Conclusions:
Older adults with migraine are at increased risk for ischemic stroke. The risk for ischemic stroke among older adults with migraine may differ by migraine medication classes.
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