Migraine attacks usually include severe headache, often accompanied by nausea, vomiting, sensitivity to light, touch, smell, or sound, as well as dizziness, visual disturbances, and tingling or numbness in the face, hands, or feet. In some cases a migraine attack can be mistaken for a cardiac event. But increasing evidence also shows that recurring migraine attacks can put people at higher risk for heart disease.

Researchers are still trying to understand exactly how migraine is linked to cardiovascular disease. According to Tobias Kurth, MD, director of the Institute of Public Health at the Charité in Berlin, there are many hypotheses surrounding the correlation, and more than one of them may be true. “The bottom line is we simply don’t know,” says Dr. Kurth. “We don’t know if migraine is part of the heart attack or stroke, or just a marker of something else. We need to be careful when making inferences, but what we can say is migraine is a marker that we can use as a characteristic that puts you at a higher risk for heart disease.” Kurth says that migraine may cause an inflammatory process in the body that could impact blood vessel health and lead to heart disease. Another theory is that genetic factors may be at play, though Kurth says this wouldn’t completely explain the strong correlation researchers have documented. “Another hypothesis that has been shown is that even in young patients with migraine, you see hyperactivity of the cardiovascular system. If you have this throughout your lifetime, you can imagine that the arteries are aging faster,” he says. “But just because you have migraine does not mean you will have any kind of heart event. Patients with migraine should not be overly concerned, but just knowing about it could prevent it.”

Stroke and Migraine

According to Islam Elgendy, MD, an assistant professor of medicine at Weill Cornell Medicine–Qatar in Doha, migraine is particularly associated with an increased risk of ischemic stroke, and the risk is higher for people who have migraine with aura, a less common type of migraine in which sensory symptoms occur, usually before the headache phase of a migraine attack. A stroke is a life-threatening condition that occurs when blood flow is cut off from the brain, and while migraine can be mistaken for stroke, research shows that migraine with aura also puts people at a higher risk of having a stroke. Aura symptoms can include visual effects, such as bright flashing lights, spots, or zigzags in the field of vision, as well as speech and language problems, such as being unable to say words, slurring, or mumbling, according to the American Migraine Foundation. Since visual changes and slurring of words are also signs of stroke, the presence of aura symptoms can lead to an initial misdiagnosis in the emergency room. But a review published in June 2020 in the British Medical Journal noted that multiple studies, including five meta-analyses, have concluded that having migraine with aura also puts people at a higher risk for ischemic stroke, though it’s unclear why. RELATED: What You Need to Know About Stroke and Migraine

Heart Disease and Migraine

According to an editorial by Kurth that was published in January 2018 in the British Medical Journal, mounting evidence shows that migraine is also a strong risk marker for nonstroke cardiovascular events, particularly heart attack. The link is so strong that the QRISK3 — an algorithm that uses traditional risk factors to calculate a person’s risk for heart disease — now lists migraine among risk factors. It’s important to note that the onset of migraine typically starts in younger populations, where heart conditions are rare, says Kurth. But over time, research suggests that migraine does put people who are otherwise healthy at a higher risk for cardiovascular disease. A Danish study mentioned in Kurth’s editorial and also published in January 2018 in the British Medical Journal, followed more than 51,000 patients with migraine and 510,000 people of the same age who did not have migraine, for 19 years. Their goal was to determine what effect migraine had on cardiovascular disease. The researchers found that having migraine put people at a higher risk for both ischemic and hemorrhagic stroke, heart attack, venous thromboembolism, atrial fibrillation, and atrial flutter, and may be an important risk factor for overall cardiovascular disease. Although migraine disease affects far more women than men, biological sex does not seem to impact the link between migraine and heart disease, says Dr. Elgendy.

Patent Foramen Ovale and Migraine

According to Kurth, migraine is often seen in people who have a hole between the right and left upper chambers, or atria, of their heart, called patent foramen ovale (PFO). According to the American Heart Association (AHA), everyone is born with this hole, but in most people, it closes a few months after the person is born. However, it remains open in roughly one-quarter of the population. The condition typically goes undetected, but it may be investigated if a person reports severe migraine, the AHA says. People who have migraine with aura are more likely to have PFO, and migraine with aura is more prevalent in people who have PFO compared with the general population, according to the American Headache Society. There’s some evidence that surgically closing a PFO can reduce migraine days in some people, particularly those who have migraine with aura. A double-blind study published in December 2017 in the Journal of the American College of Cardiology, found that among people with migraine with aura who underwent surgery to close their PFO, 49 percent had fewer migraine days 10 to 12 months later, and for about 15 percent, their migraine attacks stopped entirely. A meta-analysis of two randomized studies of PFO closure — including the December 2017 study — published online on February 8 in the Journal of the American College of Cardiology, also found that surgical closure reduced mean monthly migraine days and attacks and resulted in more participants experiencing complete cessation of migraine days than no PFO closure. Still, there were participants who did not benefit from PFO closure in the studies. As an accompanying editorial points out, researchers do not yet know which people with migraine and PFO are most likely to benefit from closure.

Postural Tachycardia Syndrome (POTS) and Migraine

Some research has shown a link between migraine and conditions that affect a person’s heart rate, though cause and effect has not yet been established. A small study published in April 2018 in the journal Neurology found that nearly all patients who had postural tachycardia syndrome (POTS) — a condition that causes heart rate to speed up when a person stands up, while blood pressure stays the same — also experienced headaches. Nearly two-thirds of participants had chronic migraine, and nearly one-third reported episodic migraine. The researchers also found that people who had chronic migraine were more likely to have abnormal blood pressure. These findings back up earlier research cited in a review published in December 2018 in the journal Autonomic Neuroscience. The findings established a strong link between migraine and POTS, and researchers have reported that between 40 and 96 percent of people who have POTS also have headache or migraine. But while “migraine might cause the heart to race due to the pain and anxiety associated with the migraine attack,” say Elgendy, “a fast heart rate does not cause migraine.”

“Although there is a link between migraine and heart disease, the actual risk is low,” says Elgendy, noting that it is still important for people with migraine, especially those with aura, to be aware that they are at a higher risk of heart disease compared with the general population. And because there is no known treatment to lower the risk of heart disease among people with migraine, specifically, focusing on a healthy lifestyle — which includes following a diet that’s high in fruits and vegetables and low in saturated fats, exercising regularly, not smoking, and maintaining a healthy body weight — are important measures anyone with migraine should be taking seriously to eliminate additional risk factors, says Elgendy.