Abstract
BackgroundMigraine carries a high global burden, disproportionately affects women, and has been implicated as a risk factor for cardiovascular disease. Migraine with aura has been consistently associated with increased risk of cardiovascular mortality. However, published evidence on relationships between migraine or non-migraine headache and all-cause mortality is inconclusive. Therefore, we aimed to estimate the effect of non-migraine headache and migraine as well as migraine subtypes on all-cause and cause-specific mortality in women.MethodsIn total, 27,844 Women’s Health Study participants, aged 45 years or older at baseline, were followed up for a median of 22.7 years. We included participants who provided information on migraine (past history, migraine without aura, or migraine with aura) or headache status and a blood sample at study start. An endpoints committee of physicians evaluated reports of incident deaths and used medical records to confirm deaths due to cardiovascular, cancer, or female-specific cancer causes. We used multivariable Cox proportional hazards models to estimate the effect of migraine or headache status on both all-cause and cause-specific mortality.ResultsCompared to individuals without any headache, no differences in all-cause mortality for individuals suffering from non-migraine headache or any migraine were observed after adjustment for confounding (HR = 1.01, 95%CI, 0.93–1.10 and HR = 0.96, 95% CI: 0.89–1.04). No differences were observed for the migraine subtypes and all-cause death. Women having the migraine with aura subtype had a higher mortality due to cardiovascular disease (adjusted HR = 1.64, 95%CI: 1.06–2.54). As an explanation for the lack of overall association with all-cause mortality, we observed slightly protective signals for any cancer and female-specific cancers in this group.ConclusionsIn this large prospective study of women, we found no association between non-migraine headache or migraine and all-cause mortality. Women suffering from migraine with aura had an increased risk of cardiovascular death. Future studies should investigate the reasons for the increased risk of cardiovascular mortality and evaluate whether changes in migraine patterns across the life course have differential effects on mortality.
Highlights
Migraine is a common chronic, intermittent primary headache disorder affecting 15% to 18% of the general adult population, mainly affecting women [1]
We present stratified participant characteristics by all headache and migraine subtypes according to the secondary classification in Additional file 1: Supplementary Table 1
For the detailed secondary categorization including migraine subtypes, the Hazard ratio (HR) for the primary outcome of all-cause mortality were 1.01 (0.92– 1.09) for the “non-migraine headache” group, 0.98 (0.85–1.13) for the “migraine with aura” group, 0.90 (0.79–1.03) for the group “migraine without aura”, and 0.98 (0.87–1.10) for the “past history of migraine” group. In this large, prospective cohort of women, we found no association between non-migraine headache or any migraine at baseline with all-cause mortality during followup
Summary
Migraine is a common chronic, intermittent primary headache disorder affecting 15% to 18% of the general adult population, mainly affecting women [1]. Individuals with migraine have a higher risk for multiple comorbid conditions, including cardiovascular disease [4,5,6,7], and some studies have linked this added risk to the aura subtype [7,8,9]. No association with all-cause mortality was observed in two large cohort studies [11, 12]. Migraine carries a high global burden, disproportionately affects women, and has been implicated as a risk factor for cardiovascular disease. Migraine with aura has been consistently associated with increased risk of cardiovascular mortality. We aimed to estimate the effect of non-migraine headache and migraine as well as migraine subtypes on all-cause and cause-specific mortality in women
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