P-Wave dispersion and atrial conduction abnormalities in migraine: implications for cardiovascular risk

Migraine is a common neurological disorder that is increasingly recognized for its systemic effects extending beyond the central nervous system. Emerging evidence suggests a potential association between migraine and cardiovascular dysfunction; however, the underlying pathophysiological mechanisms remain insufficiently elucidated. In this study we aimed to evaluate atrial electromechanical delay in patients with migraine and to test the hypothesis that migraine may be linked to subclinical cardiac alterations, particularly in atrial conduction.

This cross-sectional study included 136 participants: 55 patients diagnosed with migraine and 81 age- and sex-matched healthy controls. All participants underwent standardized clinical, electrocardiographic, and echocardiographic evaluations at a tertiary care center.

Migraine patients demonstrated significantly prolonged P max and P dispersion values compared to controls (Pmax: 196 ± 44 vs. 131 ± 42 ms, p < 0.001; Pdisp: 133 ± 44 vs. 63 ± 23 ms, p < 0.001), indicating increased intra-atrial conduction heterogeneity. Although interatrial electromechanical delay did not differ significantly between groups, migraine patients exhibited prolonged lateral and medial atrial conduction times compared to controls (p < 0.05). These abnormalities were observed despite the absence of overt cardiovascular disease.

This study supports the hypothesis that migraine is associated with subclinical atrial conduction disturbances, as evidenced by elevated P-wave dispersion and atrial electromechanical delay. These findings highlight the importance of cardiovascular monitoring in migraine patients, particularly those with aura or existing vascular risk factors. Further longitudinal investigations are necessary to determine whether these electrical changes have prognostic value in predicting future cardiovascular events.