cardiovascular disease

14 July 2023

Migraine when you’re 60+ >> A few important observations

James Discoveries & Stats, Information, Treatments 0

A useful review was published last year in the medical journal Current Pain and Headache Reports, regarding migraine in patients over the age of 60. It was brought to my attention by an article in Everyday Health last month.

It might be useful to get a quick overview of some of the report’s findings.

Many people with migraine are told that their symptoms will likely diminish or go away as they get older. And that is often the case, especially from a strictly statistical standpoint.

But you are not a statistic, you’re an individual. And the fact is that many people continue to have regular attacks into their 80s, or even start having attacks in their older years. The report found that 10% of older adults had migraine, now spread out more evenly between men and women.

If you started having attacks before the age of 18, you’re more likely to continue having attacks in later years.

How is 60+ Migraine different?

Attacks may not be different, but they can change throughout life. For example, many older adults find that:

Their headache pain is now more often two-sided
They may be less sensitive to light and noise
They may experience fewer “cranial autonomic symptoms”, such as congestion or watery eyes during an attack
Sometimes the attacks are less severe
They may experience “stroke-like” symptoms for the first time, including visual aura, trouble speaking, or difficulty with movement

How is 60+ Migraine diagnosis different?

Your headache specialist will want to make sure that you’re not suffering from other problems that become more serious with age. For example, since migraine attacks can mimic stroke, the most urgent thing with any new symptoms is to quickly rule out stroke.

Cardiovascular issues in general are important to check as well.

The report gives some helpful information about the timing of the headache. For example, if you have headaches that get worse at night, brain imaging might help with diagnosis. Headaches worse in the morning may indicate sleep problems, such as obstructive sleep apnoea.

It’s also all the more important for your doctor to know your medical history, and to watch for any current infections or other problems that may be related. It’s also very important that they pay attention to medications and supplements you may be taking, which could affect or even cause headaches.

How is 60+ Migraine treatment different?

Aside from ruling out other conditions, migraine treatment in older adults can be tricky because of concerns about medication interactions, and other contraindications (e.g. medical reasons why a medication may make another condition or risk factor worse).

CGRP related medications, although they don’t have the long-term history of other medications, are looking like a positive treatment for older adults. The study specifically mentioned lasmiditan, ubrogepant, and rimegepant. Candesartan, also used for high blood pressure, may help.

However, many older medications used for migraine may be used. Some, with newer evidence, are not as much of a concern as they used to be. So there are many other options that your doctor may suggest. The report simply gives the good advice that it’s especially helpful if you’re 60+ to start at a low dose and go up gradually. It requires patients, but it’s worth it.

Although the report briefly talks about lifestyle (diet and exercise), it doesn’t spend time talking about many non-drug treatments. These should be discussed with your doctor, but it widens the options significantly with good evidence-based treatments.

If you or someone you love is 60+ with migraine, it’s worth taking a look at this article, and the report – which is more technical, but has a lot of information.

Article: Migraine After 60: What You Need to Know
Report: Episodic Migraine and Older Adults

16 December 2021

Migraine and Irregular Heart Beat

James Discoveries & Stats, Information 0

Patients who have migraine with aura are more likely to suffer from a certain type of irregular heartbeat, according to a recent study out of Switzerland.

The condition is known as atrial fibrillation. Atrial fibrillation occurs when the heart’s upper chambers beat out of sync with the lower chambers. You end up with an irregular, and often rapid, heartbeat.

The study does not show that migraine is causing the problem, only that the two conditions often come together. And there are a number of reasons why this may be – a medication you’re taking may increase your risk of heart problems, or obesity, or even a genetic disposition. A next step would be to try to figure out what the connection is between migraine and atrial fibrillation.

However, multiple studies have suggested that patients with migraine, and especially those with migraine with aura, have an increased risk of heart conditions. Studies like these are another reminder that migraine patients should especially take care of their heart health.

Now many people may not even notice this heart problem. If you do, you may or may not feel your heart “fluttering”. But you may notice weakness or fatigue, lightheadedness or dizziness, and maybe some chest pain.

Atrial fibrillation can be dangerous because it can lead to blood clots and stroke. The researches in this study review explain the practical steps you and your doctor may take:

In practical terms, screening for atrial fibrillation in patients who have a long history of migraine might be reasonable, whereas in patients with stroke or other disorders and migraine extensive screening for atrial fibrillation should be performed like in all patients without migraine.
Migraine and Atrial Fibrillation: a Systematic Review

In other words, it might be something you want to ask your doctor about, especially if you’re a long-term migraine with aura sufferer. If you know you have increased risk of heart disease, your doctor can help you lower your risk.

7 July 2021

Migraine with Aura and Blood Clots

James Discoveries & Stats 0

A study published earlier this year in the journal Neurology may provide a clue about migraine’s link with cardiovascular conditions. The focus of the study? Blood clots.

The system that clots your blood is truly amazing. The technical term (and your word of the day) is hemostasis. Without it, even a small cut or a slightly damaged blood vessel within the body could be deadly. And yet, using an amazing series of communications and substances in the body, the blood stops flowing.

Of course, there are various diseases and conditions that can lead to problems. For some people, a cut is very serious, because there is a problem with the hemostasis system. For others, blood may clot when it’s not supposed to, causing other serious problems (thrombosis).

The recent study investigated coagulation proteins/clotting factors to see if there was any relationship with migraine with aura, or migraine without aura.

There is evidence that migraine in general, including migraine without aura, may be linked to heart conditions and stroke. But the link seems to be stronger with migraine with aura.

In this study, certain blood clotting factors (not all) were related specifically to migraine with aura. In case you’re interested, the von Willebrand factor, antihaemophilic factor A, and phosphorylated fibrinopeptide A, were all elevated in the migraine with aura patients, and fibrinogen was lower.

This is a complex system, so there is a lot of work to do to see how these blood clotting mechanisms relate to migraine. But this could be a big step toward understanding why migraine patients are at higher risk of heart disease, and it may also help us understand more about the mechanisms and causes of migraine itself.

To read another brief article on the study, check Potential causality between blood clot factors and migraine with aura at ScienceDaily.

1 June 2021

Does Magnesium Help You Live Longer?

James Discoveries & Stats, Information, Treatments 0

A recent study is highlighting the benefits of magnesium once again – not for migraine, but for long life in general.

The benefits of magnesium for migraine patients are now well-known. I have heard from many people who have found significant relief after starting on a magnesium supplement.

Of course it’s not always that simple. Some patients, for various reasons, may have lower magnesium levels than others. Getting tested will give you an idea where you’re at.

But this recent study, published in the journal Atherosclerosis (in case you don’t know, atherosclerosis refers to plaque build up in the arteries), links magnesium with cardiovascular conditions. As you may know, stroke and heart attack and various other related issues have been linked to migraine – migraine is often considered a risk factor for cardiovascular disease.

This particular study found that people with lower levels of magnesium (below 0.73 mmol/l – see more about magnesium testing here) were more likely to die from cardiovascular issues. The researchers even adjusted for other common risk factors, in case these people also happened to have other related conditions that would explain the higher death rate. Even after the adjustments, the lower magnesium was still linked to the higher death rate.

But more than that – low magnesium was also linked to “all-cause mortality”. In other words, during the specified length of time (10.1 years), those with lower magnesium levels were significantly more likely in general to die.

This study tells us very little about why this may be – a number of factors may be involved. But if people with migraine are more likely to have lower magnesium levels, and be more likely to benefit from more magnesium, and are at higher risk of cardiovascular disease – well, it’s just another reason to make sure your magnesium levels are where they should be, and consider a supplement.

An interesting side note. We’ve been talking a lot about vitamin D lately, and especially about our need to get out into the sunshine. Low vitamin D is also linked to cardiovascular problems (see this article from Johns Hopkins for a summary – Do lower vitamin D levels mean higher risk for cardiovascular disease?). And, vitamin D is also important for magnesium absorption. Magnesium is also needed for vitamin D to be properly used in your body (see Role of Magnesium in Vitamin D Activation and Function).

Of course we could go on and on about what’s related to what – the body is a pretty complex system! But in research we often see certain patterns emerging that can point us in the right direction. And there is more and more evidence that migraineurs need to pay attention to their magnesium levels, and also their vitamin D. For various reasons, these days people often have low levels of one or both – whether it be from a “typical modern diet” or too much time indoors.

For more information, check out:

11 May 2020

Women, Migraine, and Serious Disease

James Discoveries & Stats 0

A study published this year in the Journal of Headache and Pain confirms our previous concerns about migraine and heart disease – but also gives us surprising clues about cancer risk.

It was hard to come up with a title for this post, and in fact this is a complex study with no easy answers. But let’s start with an overview.

This research comes from the Women’s Health Study, a study of 27,844 women. They were 45 and older at the start of the study, which followed the women over the next two decades or so.

The study was looking for some big clues or general trends when it comes to headache and migraine and death rates. Simply put, do we see women with migraine dying at a higher rate than the general population? If so, what are they more likely to die of?

The perhaps comforting short answer is – no, women with migraine are not more likely to die sooner than women in general. But there’s more to it than that. (And in some ways, we would like to start seeing women with migraine dying later than the general population – because often times they are more aware of their health and may start taking better care of themselves!)

But there was one cause of death that was higher among women with migraine with aura specifically – that was cardiovascular disease. As we’ve noticed in other studies, migraine, and especially migraine with aura (as in this case) does seem to increase risk of cardiovascular disease.

Although some have questioned the role of migraine medication in this link, it’s interesting that, in this study, it was only migraine with aura that increased risk.

The moral of the story is the same as what we’ve been saying for years – if you have migraine, treat it. And be aware of other risk factors you may have for stroke and heart attack et cetera.

Now, for those of you who are mathematically minded, you may be asking – if there is an increased risk for cardiovascular disease, why weren’t women with migraine in general more likely to die earlier? The surprising answer – those with migraine with aura were also at a slightly decreased risk for cancer – especially female-specific cancers. So that balanced out the numbers.

Why would this be? Remember, this study was just looking for some overall clues, it doesn’t give us a lot of specific information. But researchers believe the answer could be related to hormones, which do affect both migraine and cancers.

For more on this study, see Women With Migraine, Aura Have Increased Risk of Cardiovascular Death. For all the details of the study, go to Migraine, headache, and mortality in women: a cohort study.