Are recurrent migraines linked to stroke?

In addition to the unbearable pain, migraine may also cause otherCardiovascular crisis, who should be careful?
How painful is a migraine attack? Some people who suffer from it describe it as "painful", "screaming", bloated, and the head is about to explode or split; or because the eye sockets are swollen and painful, they feel that "the eyes are about to fall out", and some even bang their heads against the wall in pain. The pain comes and is as intense as a strong pulse jumping in the brain, which is really tormenting for the body and mind.

Many people are also worried that their bodies may not be able to bear it and that a bigger internal storm will ensue.

Dr. Wang Shujun, president of the Taiwan Headache Society and director of the Department of General Neurology at Taipei Veterans General Hospital, said that in the clinic, patients often ask worriedly, "Will I have myocardial infarction, coronary artery sclerosis, or stroke?"

Some studies have confirmed that patients' anxiety may not be groundless, especially those with "typical migraine" who have signs before a migraine attack, who need to be particularly careful.

According to foreign research, aura migraine accounts for about allMigraineAbout 30% of patients have migraine with aura; and about 20% of patients in Taiwan have migraine with aura, Wang Shujun pointed out.

If his previous research is used to estimate that about 150 million people in Taiwan suffer from migraines, then at least 30 people may experience signs such as stars, flashes of light, or curved lines before a headache.

In the middle of last year (2007), a study published in the Journal of the American Medical Association tracked more than 1990 women over the age of 10 for 2 years starting from the early 7s. The results found that if women have migraine with aura, their risk of developing cardiovascular disease is 45 times that of the average person; their risk of stroke is 2.15 times; and their risk of myocardial infarction is 1.91 times.

During this period, the study subjects experienced 580 serious coronary cardiovascular disease events, such as heart attacks, strokes, and angina, and 130 people died.

Interestingly, this study on nurses published its first results in the sixth year, which found that headaches did not increase the risk of cardiovascular disease. However, after 6 years, a completely different result was found, which was beyond the researchers' expectations and caused a sensation in the outside world.

At the same time, researchers from Boston Women's Hospital and Harvard School of Public Health also found that even after taking age into account, 1 out of every 18 women suffer from cardiovascular disease each year, which is directly related to migraine with aura.

Pregnancy is a happy occasion, but...

In addition, generally speaking, when women are pregnant, the secretion of female hormones in their bodies increases, and they are less likely to have migraines. However, if you have migraines during pregnancy, you should be careful.

At the annual meeting of the American Academy of Neurology held in Boston in early May 2007, Bushnell, a researcher from the Center for Cerebrovascular Disease at Duke University Medical Center, reported that women who experience migraines during pregnancy are significantly more likely to develop stroke, heart attack or other cardiovascular diseases.

This study examined discharge data from nearly 2000 million pregnant women across the United States between 2003 and 1700, among whom approximately 3 had received treatment for migraines.

The results showed that compared with other pregnant women, women who received treatment for migraine during pregnancy were 19 times more likely to have a stroke, 5 times more likely to have a heart attack, and more than twice as likely to have heart, blood clots and other vascular diseases. In addition, women over 35 who gave birth were more likely to have migraines during pregnancy.

Although the authors of the study admitted that this study did not prove that there is a causal relationship between migraine and cardiovascular disease, but only found that the two are related, more in-depth research is needed in the future. At the same time, there is currently a lack of good indicators to help doctors identify which migraine patients are at higher risk. However, Lipton, a professor of neurology and epidemiology at the Albert Einstein College of Medicine, reminded that "people with migraines should regard migraines as important medical problems like diabetes or high blood lipids. They should all be treated in order to make today's life better and prevent tomorrow's complications."

He also reminded that people with migraines should actively receive treatment, maintain a normal weight and treat high blood pressure in order to correct risk factors that may cause heart disease and stroke.

The invisible killer of young men

Men are not immune to this either. In late April 2007, a large-scale follow-up study published in the American journal Archives of Internal Medicine, which included more than 4 male physicians aged between 40 and 84 and lasted an average of 15.7 years, pointed out that men with migraines are more likely to have heart attacks than men without migraines.

The participants did not have any heart disease, cancer or serious health conditions when they first joined the study. During the first five years of the study, 5 people reported migraines, and during the follow-up period, a total of 1449 heart disease or stroke-related events occurred.

Compared with other male subjects without a history of migraine, men with migraine have a 24% increased risk of cardiovascular disease, including a 42% increased risk of myocardial infarction.

Men with migraines are also more likely to have a stroke, but this is related to age: for men younger than 55, migraines increase the risk of stroke by XNUMX%. For older men with migraines, the increased risk is not significant and does not reach statistical significance.

Although there were some doubts from the outside world after the publication of this study, Wang Shujun reminded that migraine with aura is related to cardiovascular disease. Although fewer men suffer from migraine than women, the proportion of male migraine patients with aura is higher than the proportion of female migraine patients with aura. Male migraine patients should be alert.

For example, in his Greater Taipei Headache Survey conducted in 1997-1998, for every 1000 people who suffered at least one migraine attack a year, only 45 were male (4.5%) and 144 were female (14.4%). However, for every 100 male migraine patients, 24 had auras, while for every 100 female migraine patients, only 9 had auras.

"Men should consider migraine as a risk factor (for cardiovascular disease)," Wang Shujun urged.

The headache myth

However, people who suffer from migraines do not need to be overly nervous and cause themselves trouble.

For example, when seeing patients, Wang Shujun is often asked, "Will the pain be enough to cause a stroke?"

"The answer is 'almost never', very rarely." Wang Shujun pointed out that only 1000 out of every 6 stroke patients (0.6%) will have a migraine attack leading to a stroke, especially patients with "migraine infarction" who have migraine aura symptoms for more than 1 hour and have stroke lesions revealed by CT or MRI. It is worth noting that migraine attacks directly lead to strokes, mostly in patients with migraine aura.

Even among young stroke patients under 45 years old, the proportion of stroke due to migraine pain is slightly higher, at 1000 out of every 37 young stroke patients (3.7%). Wang Shujun still emphasized that the probability of occurrence is still rare, "Don't be (overly anxious) and think that you will have a stroke due to the pain."

On the other hand, although 27% of stroke patients experience headaches, these are mainly those with a history of headaches, or those who have suffered a stroke in the back of the brain, especially in the cerebellum, or those who are younger when they have a stroke. These people are more likely to experience headaches at the time of the stroke.

Moreover, headache is rarely the only symptom of stroke. If there are other signs of stroke (such as limb weakness, numbness or paralysis of one hand or foot, etc.) plus headache, you need to be more concerned about the risk of stroke or transient cerebral ischemia. Otherwise, the chance of stroke is very low if there is only headache.

However, Wang Shujun also reminded that studies have found that people with frequent migraine attacks (more than once a month) are more likely to have small ischemic lesions in the brain, even if the patients have no history of stroke. In particular, the risk of ischemic or infarct lesions found in brain imaging examinations for migraine patients with aura is 1 times higher than that of people without aura. It is recommended that patients with aura migraine, regardless of whether they have had a stroke or not, should consult a doctor for brain imaging examinations if the attacks are frequent, so as to detect asymptomatic stroke points early.

You can do this

In 2000, the World Headache Association established guidelines for migraine patients on how to prevent stroke, including:

◆If migraine patients want to prevent stroke, the first thing they should do is to have warning signs.

◆If you often have migraine with aura, avoid taking drugs such as ergotamine, which are used to treat migraine but can cause vasoconstriction, and discuss adjusting your medication with your doctor.

◆Reduce other risk factors for stroke, including not smoking, not drinking, and not taking female contraceptive pills. Especially those who have frequent headaches or migraines with auras, or those who have increased headache frequency or longer auras, should never take contraceptive pills.

Wang Shujun also reminded that men who have migraines may increase the risk of cardiovascular disease and should have regular health checks to see if they have high blood pressure, diabetes, or high cholesterol. They should also avoid smoking, drink less, etc. They should also know how to adjust their pace of life and reduce stress. Too much stress can easily cause headaches, and long-term and frequent headaches can increase the risk of stroke and cerebral ischemia.

In addition to avoiding drugs that cause vasoconstriction (such as ergot alkaloids), migraine patients should also avoid using too many painkillers purchased on the market, otherwise it will also cause blood pressure to rise. If headaches are frequent, do not always rely on painkillers. You should take headache prevention drugs regularly to reduce headache attacks. Some headache prevention drugs can also reduce high blood pressure, such as beta-blockers, which are also good for the heart, Wang Shujun reminded.

In addition, he suggested that migraine patients who seek medical treatment for other cardiovascular problems should proactively inform their doctors of their history of migraines and adjust their medications, because he observed that migraine patients often take inappropriate cardiovascular medications, which exacerbates their headaches.

For example, commonly used "vasodilators" in clinical practice include Persantin (Chinese names such as: Xinkangning Tablet, Beizhenxin Tablet, Weinuoxin, etc.) and Aggrenox (Chinese names such as: Naokangping) for preventing cardiovascular diseases, which contain the ingredient Dipyridamole (Chinese name: Daipilida). "(After patients take it,) the blood vessels dilate and they often feel terrible pain," said Wang Shujun.

There is also a class of angina pectoris drugs containing nitrates, including Isordil (Chinese name: Aisude, Yishibei), Ismo-20 (Chinese name: Aishumai), Imdur (Chinese name: Kuanxin), etc., which often make many patients' headaches worse. One-minute medical classroom

What is a migraine with aura?

Have you ever had a headache so severe that you wanted to vomit, so severe that you wanted to rest, or so severe that you were afraid of light? If two of the above three conditions match your experience, it could be a migraine. Wang Shujun, chairman of the Taiwan Headache Society, provides this quick test method.

As for migraine aura, there are some special and "recoverable" neurological symptoms before the headache occurs, which usually lasts about 20 minutes.

The Mayo Headache Encyclopedia written by the Mayo Clinic in the United States points out that visual disturbances are the most common signs of migraines, such as: seeing stars, colorless spots, flashes, curved lines or shapes, blind spots spreading in the field of vision, blurred or hazy vision... In addition, there may also be signs such as numbness and tingling of the skin, weakness of the limbs, or slurred speech and speech disorders such as inability to understand what others are saying.