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Tobias Kurth, MD, ScD; J. Michael Gaziano, MD, MPH; Nancy R. Cook, ScD; Vadim Bubes, PhD; Giancarlo Logroscino, MD, PhD; Hans-Christoph Diener, MD, PhD; Julie E. Buring, ScD

Arch Intern Med. 2007;167(8):795-801.

Background  The vascular component of the migraine-specific physiologic profile and the observed adverse cardiovascular risk profile in migraineurs suggest an association between migraine and cardiovascular disease (CVD). In women, migraine has been associated with increased risk of CVD, including coronary events. Compatible data in men are lacking.

Methods  Prospective cohort study of 20 084 men aged 40 to 84 years participating in the Physicians' Health Study. In yearly questionnaires, men were asked for information on migraine, risk factors, and the occurrence of study end points. We classified men as having migraine if they indicated migraine during the first 5 years, after which time follow-up began. Information on aura was not available. All the men were free of CVD at the start of follow-up. During a mean of 15.7 years, we followed up participants for the occurrence of a first major CVD event (nonfatal ischemic stroke, nonfatal myocardial infarction, or death from ischemic CVD). We also evaluated the individual end points, coronary revascularization, and angina.

Results  A total of 1449 men (7.2%) reported migraine, and during follow-up, 2236 major CVD events occurred. Compared with nonmigraineurs, men who reported migraine had multivariable-adjusted hazard ratios (95% confidence intervals) of 1.24 (1.06-1.46; P = .008) for major CVD, 1.12 (0.84-1.50; P = .43) for ischemic stroke, 1.42 (1.15-1.77; P<.001) for myocardial infarction, 1.05 (0.89-1.24; P = .54) for coronary revascularization, 1.15 (0.99-1.33; P = .068) for angina, and 1.07 (0.80-1.43; P = .65) for ischemic cardiovascular death.

Conclusion  In this large prospective cohort of apparently healthy men, migraine was associated with increased risk of major CVD, which was driven by increased risk of myocardial infarction.

Author Affiliations: Divisions of Preventive Medicine (Drs Kurth, Gaziano, Cook, Bubes, and Buring) and Aging (Drs Kurth, Gaziano, Logroscino, and Buring), Department of Medicine, Brigham and Women's Hospital, and Department of Ambulatory Care and Prevention (Dr Buring), Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard School of Public Health, Boston (Drs Kurth, Cook, Logroscino, and Buring); Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston (Dr Gaziano); and Department of Neurology, University of Duisburg-Essen, Essen, Germany (Dr Diener).

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