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Can Heart Issues Cause Migraines

Migraine Treatment When Cardiovascular Disease Is Present

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Unfortunately, any migraine treatment that decreases the width of a blood vessel, even very temporarily, cannot be used in those who have or might have cardiovascular disease. In those who are at increased risk by uncontrolled blood pressure, high cholesterol, or several risk factors, such as smoking, diabetes, obesity, and heredity, these risk factors need to be treated and consideration be given to cardiac testing, such as exercise treadmill or nuclear stress test. It is estimated that triptans , as well as DHE, can narrow heart blood vessels by 18%. While this is a minor narrowing for a person with normal heart vessels, in those with cholesterol build up, it can become significant.

All non-steroidal anti-inflammatory drugs , such as ibuprofen, diclofenac, and naproxen, now carry a black box label from the US Food and Drug Administration because of their association with increased risk of heart attack. NSAIDs do vary in the amount of risk to the heart, with naproxen the safest. Other NSAIDs vary in their heart risk, mostly seen in those who use them frequently. Using NSAIDs not more than 2 days a week is generally safe in most individuals who have never had a heart attack. Other acute, as-needed medications that may help dial down the migraine pain without causing blood vessel narrowing include metoclopramide, prochloperazine, diphenhydramine, baclofen, acetaminophen, and gabapentin. Trigger point injections and nerve blocks may also be used.

Deborah Tepper, MD

How Are Migraines Diagnosed

To diagnose a migraine, your healthcare provider will get a thorough medical history, not just your history of headaches but your familys, too. Also, they’ll want to establish a history of your migraine-related symptoms, likely asking you to:

  • Describe your headache symptoms. How severe are they?
  • Remember when you get them. During your period, for example?
  • Describe the type and location of your pain. Is the pain pounding? Pulsing? Throbbing?
  • Remember if anything makes your headache better or worse.
  • Tell how often you get migraine headaches.
  • Talk about the activities, foods, stressors or the situations that may have brought on the migraine.
  • Discuss what medications you take to relieve the pain and how often you take them.
  • Tell how you felt before, during and after the headache.
  • Remember if anyone in your family gets migraine headaches.

Your healthcare provider may also order blood tests and imaging tests to make sure there are no other causes for your headache. An electroencephalogram may be ordered to rule out seizures.

How Can They Be Stopped

Migraine sufferers can cut an attack short with one of the triptan drugs, a class that includes eletriptan , sumatriptan , and zolmitriptan . The triptan drugs seem to work by inhibiting pain signaling in the brainstem. They also constrict blood vessels, so people with a history of cardiovascular disease are usually advised not to take them.

Pain relievers like ibuprofen and naproxen can halt a mild attack, but rebound headaches may develop if they’re taken too often. Rebound headache occurs after the body gets used to having a medication in its system when it’s not there, headaches happen. Migraines can quickly snowball into more serious pain, so it’s important to treat the headache early, regardless of the medication.

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Recent Research Indicates That Women With Migraine May Be More Likely To Suffer From Cardiovascular Disease Find Out More

New research presented at a recent meeting of the American Headache Society shows a possible link between cardiovascular disease and migraine: A large study found that women migraineurs were 1.52 times more likely to have cardiovascular disease, including stroke or heart attack.

Heres a look at the preliminary findings.

Could My Other Health Problems Be Causing My Headaches

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    Many conditions can cause headache pain. For instance, the flu, colds, toothaches, and allergies can all cause headaches. Stuffy sinuses from allergies and pain from sore teeth or gums can cause facial pain. That pain can then spread to other parts of your head. The following conditions could cause your headache.

    Allergies. Sometimes allergies can bring on bad headaches. Allergy headaches are usually accompanied by other symptoms such as the following.

    • watery eyes
    • wheezing

    Being sensitive to a substance that is one of your triggers is not the same as having an allergy. You may be sensitive to aged cheese, which causes a migraine headache. But that is not an allergy. It is important to figure out whether you have sensitivities or allergies because the treatments for allergies and headaches are very different. In both cases, though, you will want to avoid or limit your exposure to the things that cause these reactions. If you have a family history of allergies and believe you may have allergies, tell your doctor. Some adjustments in your treatment may help with your headaches.

    Sinusitis. Sinusitis is a viral or bacterial infection in the lining of your sinuses. Sinuses are air-filled spaces around your nose and in your face. Sinusitis feels like a dull, deep ache around your nose and sometimes your forehead and ears. The pain usually gets worse with changes in the weather or when you cough, sneeze, bend over, or move your head suddenly.

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    Some People Who Get These Intense Throbbing Headaches May Face A Heightened Risk Of Stroke And Heart Attack

    About one in six adults in the United States reports having migraines, but these debilitating headaches are three times more prevalent in women. During a migraine attack, people often feel nauseated and are sensitive to light and sound. And up to a third of migraineurs experience odd visual or physical sensations known as an aura .

    Usually, the aura occurs soon before the headache, although some people experience just the aura without a headache. Both versions are known as migraine with aura or classic migraine. And both have long been linked to an increased risk of cardiovascular disease, especially stroke. But migraine sufferers should interpret this risk in context, says Dr. Christopher Anderson, chief of stroke and cerebrovascular diseases at Harvard-affiliated Brigham and Women’s Hospital.

    “Migraines tend to be most common in younger women, and their baseline risk of stroke is quite low in the first place,” Dr. Anderson explains. The latest evidence comes from a 2020 study in JAMA of nearly 28,000 women who were part of the Women’s Health Study. All were ages 45 or older and had no evidence of cardiovascular disease when the study began in the early 1990s. Researchers tracked the women’s health until 2018.

    Just 5% of the participants reported having migraine with aura. Their annual rate of heart attack, stroke, or death from cardiovascular disease was slightly higher than the rate among women who had migraines without aura or no migraines .

    Migraine And Cardiovascular Disease

    The presence or absence of cardiovascular disease can influence the risks associated with migraine, as well as the choice of optimal treatment. Migraine itself is considered a primary headache disorder, that is, it is not caused by an underlying disease. However, much time has been spent studying diseases that appear to occur more frequently in migraineurs. If these diseases are seen more frequently in those who have migraine compared with the general population, they are called comorbid disorders. Another source of investigation is whether, if these comorbid disorders are effectively managed, the migraines will improve or become more treatable.

    It is common to think of migraines as being related to blood vessels or vascular in origin, despite evidence to the contrary. There is a throbbing nature to the pain, and that suggests blood vessels. Migraines worsen with stress and exercise, are associated with an increase in blood pressure with pain, and have symptoms that at times can resemble strokes.

    Cardiovascular conditions believed to be possibly increased in frequency with migraine include Raynauds phenomenon , high blood pressure , and ischemic heart disease. Structural heart conditions are sometimes linked with migraine and these include changes in the heart chambers and valves. These disorders are not believed to cause migraine, but they may occur more frequently in those who have migraine.

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    Who Gets Migraines What Are The Risk Factors

    Its difficult to predict who may get a migraine and who may not, but there are risk factors that may make you more vulnerable. These risk factors include:

    • Genetics: Up to 80% of people who get migraine headaches have a first-degree relative with the disease.
    • Gender. Migraine headaches happen to women more than men, especially women between the ages of 15 and 55. Its likely more common in women because of the influence of hormones.
    • Stress level. You may get migraines more often if youre high-stress. Stress can trigger a migraine.
    • Smoking.

    How To Tell Your Neck Pain Might Be Caused By A Heart Problem

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    A good tipoff is the presence of certain additional symptoms.

    While many different disorders can cause anterior neck pain, neck pain associated with difficulty breathing, chest pain, feeling flushed or sweating, or palpitations should raise suspicion for acute cardiac pathology, explains Sendhil Krishnan, MD, a board-certified adult general cardiologist with advanced subspecialty training in interventional cardiology.

    Dr. Krishnan adds, The reason for the association of neck and jaw pain with cardiac problems has to do with cranial nerve X , also known as the vagus nerve.

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    What Triggers A Migraine

    There are too many triggers to list them all here. Many migraine sufferers are sensitive to strong sensory inputs like bright lights, loud noises, and strong smells. Lack of sleep is a trigger, but so is sleeping too much, and waking up from a sound sleep because of a headache is a distinctive characteristic of migraine. Many women have menstrual migraines associated with a drop in estrogen levels. Alcohol and certain foods can start a migraine.

    One of the most common triggers, stress, is one of the hardest to control. Interestingly, migraines tend to start not during moments of great stress but later on, as people wind down.

    Previous Research Highlights Migraine With Aura

    Additionally, the study results did not differentiate between migraines without aura and migraines with aura .

    This is unfortunate because previous studies have shown that women with this type of migraine have an increased risk for cardiovascular disease. 1 For example, a study from 2010, called the Womens Health Study, followed over 27,000 women for more than 11 years. In this study, women self-reported whether they had experienced migraines. Women with migraines with aura had twice the risk of having cardiovascular disease compared to women without a history of migraines.

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    A Cardiac Solution To A Neurological Problem

    Migraine headaches remain poorly understood, and there are likely a number of underlying causes that result in their symptoms. Recent research studies have identified a possible link between migraine with aura and a congenital heart defect known as patent foramen ovale .

    The foramen ovale is a flap in the atrial septum, the wall located between the upper chambers of the heart, the left and right atria. While the flap is a critical part of the fetal circulation, and is present in all babies as the heart forms, its supposed to close on its own after birth. But in about 25% of the population, the hole remains open, Dr. Sommer explains.

    In the vast majority of cases, a PFO causes no health problems, but complications can arise. With a hole in the septum, non-oxygenated blood from the right side of the heart can enter the left side and mix with the oxygenated blood leading to symptoms of shortness of breath. The hole may allow for tiny clots, normally present on the right side of the heart, to cross over to the left side and, from there, travel to the brain, causing strokes.

    The Migraine And Heart Disease Link: Migraine Auras Matter

    Heart Disease and Stroke

    The researchers used four methods to analyze the data for shared genetic variants that overlap between Migraine and heart disease. Even though evidence suggests that people with Migraine with aura have a greater risk for heart disease than those with Migraine without aura, researchers found no common gene variations between Migraine with aura and heart disease.

    However, they did find common genetic variations in Migraine without aura and heart disease. Surprisingly, those shared genes actually protect against heart disease rather than increase the risk.

    “In other words, people with Migraine without aura seem to have a lower load of genetic factors increasing the risk of heart disease,” Dr. Anne Ducros, who wrote an editorial accompanying the study, said in a news release from the American Academy of Neurology.

    “We now need to understand why people with Migraine who are born with a protective or neutral genetic risk for heart disease end up with an increased risk for heart problems,” Ducros said.

    Dr. Ducros added that genetic factors not included in these studies could still affect the risk of heart disease among those with Migraine. She also suggested that nongenetic factors like obesity, lack of exercise, smoking, and depression that all increase the risk of heart disease may be involved in the Migraine and heart disease link.

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    Heart Disease And Migraine

    According to an editorial by Kurth that was published in January 2018 in the British Medical Journal, mounting evidence shows that migraine is also a strong risk marker for nonstroke cardiovascular events, particularly heart attack. The link is so strong that the QRISK3 an algorithm that uses traditional risk factors to calculate a persons risk for heart disease now lists migraine among risk factors.

    Its important to note that the onset of migraine typically starts in younger populations, where heart conditions are rare, says Kurth. But over time, research suggests that migraine does put people who are otherwise healthy at a higher risk for cardiovascular disease.

    A Danish study mentioned in Kurths editorial and also published in January 2018 in the British Medical Journal, followed more than 51,000 patients with migraine and 510,000 people of the same age who did not have migraine, for 19 years. Their goal was to determine what effect migraine had on cardiovascular disease. The researchers found that having migraine put people at a higher risk for both ischemic and hemorrhagic stroke, heart attack, venous thromboembolism, atrial fibrillation, and atrial flutter, and may be an important risk factor for overall cardiovascular disease.

    Although migraine disease affects far more women than men, biological sex does not seem to impact the link between migraine and heart disease, says Dr. Elgendy.

    Ocular Migraines And Heart Disease

    Migraines are a condition suffered by around 39 million people in the United States, and studies suggest that migraines are linked to heart disease specifically ocular migraines. Although migraines are a neurological disorder, evidence suggests there is a higher risk of stroke and heart attack in patients who suffer from ocular migraines.

    Ocular migraines are migraine headaches which are accompanied by what is known as migraine aura. This subtype of migraine involves visual abnormalities that occur typically just before a migraine sets in, or during the attack. Migraine aura affects about 20% of migraine sufferers. These auras typically last around 30 minutes or less, as opposed to the actual migraine pain which can last anywhere from hours to days.

    Ischemic stroke and hemorrhagic stroke are the two types of stroke most associated with migraines. Women are far more likely to suffer from migraines than men, and women who experience migraine aura are 2 to 3 times more likely to have a stroke than women who do not. They are also more likely to experience a stroke than men who suffer from migraine aura.

    Patients who experience migraines are also about 2 times more likely to suffer from heart attacks or heart rhythm disorders. Those who have traditional risk factors for stroke or heart attack, such as high blood pressure or diabetes, in addition to migraines, showcase the strongest association between migraines and heart disease.

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    Patent Foramen Ovaleand Migraine

    According to Kurth, migraine is often seen in people who have a hole between the right and left upper chambers, or atria, of their heart, called patent foramen ovale . According to the American Heart Association , everyone is born with this hole, but in most people, it closes a few months after the person is born. However, it remains open in roughly one-quarter of the population. The condition typically goes undetected, but it may be investigated if a person reports severe migraine, the AHA says.

    People who have migraine with aura are more likely to have PFO, and migraine with aura is more prevalent in people who have PFO compared with the general population, according to the American Headache Society.

    Theres some evidence that surgically closing a PFO can reduce migraine days in some people, particularly those who have migraine with aura. A double-blind study published in December 2017 in the Journal of the American College of Cardiology, found that among people with migraine with aura who underwent surgery to close their PFO, 49 percent had fewer migraine days 10 to 12 months later, and for about 15 percent, their migraine attacks stopped entirely.

    What Exactly Is A Migraine

    PFO Treatment Can Help Stop Migraines

    The “classic” migraine is preceded by aura, which typically consists of strange visual disturbances zigzagging lines, flashing lights, and, occasionally, temporary vision loss. Numbness and tingling affecting one side of the lips, tongue, face, and the hand on the same side may also occur. But only about a third of migraine sufferers experience aura, and fewer still with every attack.

    The migraine headache, with or without aura, often but not always produces pain that usually begins on one side of the head. A migraine headache also often has a pulsating quality to it. Many people experience nausea, extreme sensitivity to light or sound, or both.

    It’s also possible to confuse other sorts of headaches with migraines. Migraines can cause nasal congestion and a runny nose, so they’re sometimes mistaken for sinus headaches. And the regular headache that most of us have experienced can have some of the features of a migrainous one, such as unilateral pain and nausea.

    In short, arriving at a definition and diagnosis for migraine is complicated. Yet a simple headache diary keeping track of headaches and factors that might have provoked them can be very helpful in making a diagnosis.

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