Migraine With Visual Aura Associated With Increased Risk of AF

In a recent study, researchers looked to analyze the association of migraine that presents with visual aura with atrial fibrillation (AF), as migraines with a visual aura are associated with a cardioembolic stroke risk.

Researchers enrolled 11,939 participants into the Atherosclerosis Risk in Communities Study, a longitudinal, community-based cohort trial. Patients were interviewed regarding their migraine history between 1993-1995 and were followed for incident AF through 2013.

Of the patients that were assessed for headache and had no prior history of AF or stroke, 426 reported migraines with visual aura, 1090 reported migraines without visual aura, 1018 reported non-migraine headache, and 9405 reported no headache.

Over the 20-year follow up period, a significant difference was found between patients with migraine versus patients without headache in the incidence of AF. Incident AF was found in 232 (15%) of 1516 participants with migraine and 1623 (17%) of 9405 without headache.

The authors demonstrated that migraine with visual aura was associated with increased risk of AF compared with participants with no headache (hazard ratio [HR] 1.30, 95% CI 1.03-1.62) as well as when compared with migraine without visual aura (HR 1.39, 95% CI 1.05-1.83). Furthermore, incident AF was also found in 80 (18%) of the 440 patients with migraine with visual aura and 152 (14%) of 1105 migraine without visual aura participants.

Overall, the data produced by the study suggest that AF may be a potential mediator of migraine with visual aura—stroke risk. The researchers noted that this association may potentially lead to ischemic strokes. In terms of confirming these results in future studies, the authors recommended that a randomized trial “may help ascertain whether patients with migraine with visual aura may benefit from AF detection and subsequent anticoagulation or antiplatelet therapy as a primary stroke prevention strategy.”

Reference

Sen S, Androulakis XM, Duda V, et al. Migraine with visual aura is a risk factor for incident atrial fibrillation: a cohort study. Neurology. 2018;91(24):e2202-e2210.