Women who have migraines with visual problems have increased risk for heart disease, according to a study published on Wednesday in the Journal of the American Medical Association, Long Island Newsday reports. For the study, researchers at the Harvard School of Public Health and Brigham and Women's Hospital analyzed the records of 27,800 women older than age 45 who participated in the Women's Health Initiative. None of the women had heart disease when they entered the study between 1992 and 1995. Researchers focused on the records of 5,125 women who had a history of migraines. According to the study, participants who had migraines with migraine aura had more than twice the normal risk for major cardiovascular events. Migraine aura "is a visual sensation -- like lights flashing or lines zigzagging, with some reports of temporary blindness" -- that often lasts for 20 minutes to one hour before migraines begin, Newsday reports. Women who had migraines without migraine aura did not have an increased risk for major cardiovascular events, the study finds. Lead study author Tobias Kurth said that researchers did not determine the cause of the link between migraine aura and heart disease and that the increased risk was small, with about 18 additional cases of heart disease per 10,000 women with migraine aura. Mark Gudesblatt, a neurologist at South Shore Neurologic Associates, said, "It's an important study because it tells you not to take these things lightly" (Talan, Long Island Newsday, 7/19).

Study Authors Did Not Report Financial Ties
The six authors of the study did not disclose to JAMA that they have consulted for, or received research funds from, pharmaceutical companies that manufacture treatments for heart disease or migraines, the AP/Miami Herald reports. JAMA in January implemented a policy that requires financial disclosures from researchers before acceptance of studies for publication, and an editorial published in the journal last week indicated that "JAMA was getting tougher as a result of ... recent breaches" of the policy, the AP/Herald reports. JAMA Editor in Chief Catherine DeAngelis said that journal editors were not aware of the financial ties until the Associated Press informed her about them last week. The authors said they did not report the financial ties because the study does not promote a treatment. JAMA on Tuesday published online a letter from the authors of the study to explain their failure to disclose the financial ties, as well as a response from DeAngelis and a correction. DeAngelis said that the letter, her response and the correction will appear in a future print edition of JAMA. "Let me decide what's pertinent or not," DeAngelis said, adding, "Authors should always err on the side of full disclosure." Kurth in an interview said that the financial ties "do not represent a conflict of interest" (Tanner, AP/Miami Herald, 7/19). 

Women who have migraine headaches with visual symptoms (or aura) may be at increased risk for stroke compared to women who do not have migraines, researchers reported in Stroke: Journal of the American Heart Association.

The risk association between stroke and migraines also increases when other factors are added, such as recent onset of these headaches, smoking and oral contraceptive use.

"Women with recent onset of probable migraine with visual symptoms (within the prior year) were almost seven times more likely to have a stroke compared to women with no history of migraine," said Steven Kittner, M.D., M.P.H., senior author of the study and staff physician at Baltimore Veterans Affairs (VA) Medical Center. "Eight percent of stroke cases had onset of probable migraine with visual symptoms in the prior year compared to one percent of controls.

"Second, and probably the most important finding, women who had probable migraine with visual symptoms who also smoked and used oral contraceptives had seven times the risk of stroke than women who had probable migraine with visual symptoms alone."

Migraine and stroke share some common risk factors, including high blood pressure and patent foramen ovale (PFO); both have a hereditary basis. While a baby grows in the womb, he or she has a normal opening between the heart's left and right atria (upper chambers). If this opening doesn't close naturally soon after the birth, the hole is called PFO.

Furthermore, migraine has long been regarded as a risk factor for ischemic stroke (stroke caused by a blot clot blocking blood flow to the brain). Few prior studies have addressed the different potential reasons for an association between migraine and stroke.

Researchers analyzed stroke incidence among 386 women 15-to 49-years-old with a first ischemic stroke and 614 women of similar ages and ethnicities who had not had stroke. Based on their responses to a questionnaire, the women were classified into three categories: having no migraine; probable migraine without visual aura; or probable migraine with visual aura.

Kittner and colleagues also reported that, compared to women with no history of migraine, women with probable migraine with visual symptoms had a 1.5 greater risk of ischemic stroke.

"Young women with probable migraine with visual symptoms can reduce their risk of stroke by stopping smoking and finding alternatives to the use of estrogen-containing contraceptives," said Kittner, who is also professor of neurology at the University of Maryland School of Medicine and director of the Maryland Stroke Center in Baltimore, Md.

As alarming as the findings sound, the chance that a woman in the 15-to-44-age group will have an ischemic stroke is very low -- one-to-two for every 10,000 people each year, Kittner said.

However, neurologists and other doctors should encourage their patients who have migraine with associated visual symptoms to minimize other stroke risk factors, he said.

"More work is also needed regarding whether patent foramen ovale mediates the association between probable migraine with visual symptoms and ischemic stroke," Kittner said. "We did not find evidence that this was the case, but had limited data to address this question.

"Other investigators should confirm our findings of an increased risk of stroke associated with recent onset of probable migraine with visual symptoms." 

Women with chronic headache, especially migraines, are more likely to be depressed, feel tired, and have a host of other severe physical symptoms, according to a study published in the January 9, 2007, issue of Neurology, the scientific journal of the American Academy of Neurology.

The study involved 1032 women at headache clinics in five states. Of the women surveyed, 593 reported episodic headache (fewer than 15 headaches per month) and 439 had chronic headache (more than 15 headaches per month). Ninety percent of the women were diagnosed with migraines.

The study found women with chronic headache were four times more likely than those with episodic headache to report symptoms of major depression. Chronic headache sufferers were also three times more likely to report a high degree of symptoms related to headache, such as low energy, trouble sleeping, nausea, dizziness, pain or problems during intercourse, and pain in the stomach, back, arms, legs, and joints.

Among patients diagnosed with severely disabling migraine, the study found the likelihood of major depression increased 32-fold if the patient also reported other severe symptoms.

"Painful physical symptoms may provoke or be a manifestation of major depression in women with chronic headache, and depression may heighten pain perception," said study author Gretchen Tietjen, MD with the University of Toledo-Health Science Campus and a member of the American Academy of Neurology. "This relation between migraine and major depression suggests a common neurobiology."

Tietjen says studies are underway to test whether severe headache, severe physical symptoms and major depression may be linked through dysfunction of serotonin in the central nervous system.

"Regardless of what's causing the link between migraine and depression, psychiatric disease such as depression complicates headache management and can lead to poorer outcomes for headache management," said Tietjen.

The study was supported, in part, by the American Headache Society, which estimates 18 million American women are affected by headache.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson disease, and multiple sclerosis.