Study Finds Migraine Is a Risk Factor for Peripheral Artery Occlusive Disease

The presence of migraine is a significant risk factor for the development of subsequent peripheral artery occlusive disease (PAOD), according to results of a retrospective cohort study published in the International Journal of Environmental Research and Public Health.

PAOD, also known as peripheral arterial disease or peripheral vascular disease, is most commonly caused by atherosclerosis, which can lead to “stenosis or occlusion of an artery and presents as intermittent claudication and critical limb ischemia,” authors explained.

The majority of patients who develop PAOD are in their 60s or 70s, and men tend to experience more severe cases of PAOD. Cigarette smoking, diabetes, hypertension, and coronary artery disease are additional known risk factors for PAOD.

Previous study findings have shown that migraine may be a risk factor for stroke; however, research on migraine and PAOD is limited. “Since both migraine and PAOD share the similar feature of vascular abnormality, and ischemic stroke is correlated to the occurrence of not only migraine but also PAOD, migraine may be an indicator of subsequent PAOD,” the authors hypothesized.

They gleaned data from the National Health Insurance Research Database (NHIRD) in Taiwan, which contains information on more than 99% of the country’s population. The analysis used a data set including patients randomly sampled from the NHIRD from 2005 and linked to those registered between January 2000 and December 2015.

Patients were considered to have newly diagnosed migraine if claims indicated they received migraine-related diagnostic codes in more than 3 outpatient visits or upon 1 admission. A total of 37,288 individuals were included in the study group (having been diagnosed with migraine) and 37,288 individuals were enrolled in the control group. PAOD development was only included in the study if it occurred after migraine onset.

Analyses revealed:

• 885 individuals in the study group and 530 individuals in the control group developed PAOD.
• The study group had a higher cumulative incidence of PAOD compared with controls according to the Kaplan–Meier curves (log-rank P < .001).
• The study group had a significantly higher adjusted HR for PAOD (1.65; 95% CI, 1.48-1.84; P < .001).
• Additional risk factors related to PAOD included chronic kidney disease and asthma.
• For individuals without certain systemic diseases, the HR of subsequent PAOD was significantly higher in migraineurs than in control individuals (all P < .001).
• Risk of PAOD was higher in both men and women with migraine (both P < .001) compared with controls.
• Significant amounts of time between migraine onset and subsequent PAOD were observed, implying that migraine may be an early predictor for PAOD.

“Migraine has long-term been considered as a primary headache rather than a disease with cardiovascular comorbidity,” the researchers wrote. “Still, according to the results of the current study, it is worth emphasizing that migraine may link with risk of PAOD, even among patients without diabetes or hypertension.” However, underlying mechanisms accounting for the correlation between migraine and PAOD are still unclear.

“Since PAOD can lead to severe limb ischemia and permeant disability, subjects with prolonged migraine should be referred to cardiovascular departments periodically to monitor the possible development of PAOD and manage it in the early phase,” the researchers concluded. They noted that future prospective studies evaluating whether migraine treatment will impact the risk of PAOD development ought to be carried out.

Reference

Kuo F, Lee C, Li J, et al. Migraine as a risk factor for peripheral artery occlusive disease: a population-based cohort study. Int J Environ Res Public Health. Published online November 18, 2020. doi:10.3390/ijerph17228549