Statins for Migraineurs?
If migraine is fundamentally an inflammatory problem and if inflammatory conditions increase cardiovascular risk, do migraineurs need statins?
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Are migraines with aura another reason for you to think about prescribing a statin?
That question is the subject of an editorial just published in the British Journal of General Practice.1 The author, David Kernic, cites evidence of a significantly increased risk of cardiovascular disease for those with migraine with aura.2-5 One meta-analysis showed a twofold increased risk of ischemic stroke associated with migraine with aura but not migraine without aura.3 Another study points to evidence of a doubling of risk for ischemic heart disease in patients with migraine with aura.4 Headache frequency is also associated with heightened cardiovascular risk: those who experience more than 12 attacks a year appear to be especially vulnerable.5
Mechanisms that may increase vascular risk in patients with migraine with aura? Possibilities include:
. Endothelial dysfunction
. Platelet abnormalities
. Microemboli
. Drug-induced
Kernic notes that in the UK, the National Institute for Health and Care Excellence has recommended the introduction of statins when any patient's 10 year risk of cardiovascular disease is 10%. Kermic suggests that until more data become available, clinicians who are considering statin therapy for a patient with migraine with aura multiply 10 year risk for females by 2.5 and by 1.5 for males. He suggests lowering treatment thresholds for younger patients and for those who experience more than 12 migraine events a year. And finally, he suggests discussing modification of other CV risk factors (eg, smoking, cholesterol level, and blood pressure) with patients.
References:
1. Kernick D. Statins for all: should patients who have migraine with aura be on a statin? Brit J General Practice. November 1, 2015.
2. Spector J, Kahn S, Jones M, et al. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med. 2010;123:612–624.
3. Schurks M, Rist P, Bigal M, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009;339:b3914.
4. Wang Y, Lin C, Ho Y, et al. Increased risk of ischemic heart disease in young patients with migraine: a population-based, propensity score-matched, longitudinal follow-up study. Int J Cardiol. 2014;172:213–216.
5. MacClellan L, Giles L, Cole J, et al. Probable migraine with visual aura and risk of ischaemic stroke: the stroke prevention in young women study. Stroke. 2007;38:2438–2445.
