Migraine linked to Rose angina but not CHD

Migraine's association with Rose angina is probably not related to coronary artery disease, according to data from the US Atherosclerosis Risk in Communities Study.Investigators report that participants of the Atherosclerosis Risk in Communities (ARIC) Study with a history of migraines or headaches were more likely to have a history of Rose angina than those who did not experience migraines or headaches. However, they were no more likely to suffer a CHD event.The investigators examined data from 12,409 African American and white men and women who participated in the ARIC study. Triennial clinic examinations between 1987 and 1998 and annual telephone interviews ascertained headache status (migraine with aura, migraine without aura, other headaches with aura, other headaches without aura, or no headaches), history of Rose angina and verified CHD events. Triptans -migraine medications associated with chest pain and coronary events - were not available at the time of data collection.The authors describe their results after adjusting for potential confounders: "...Both men and women with migraine with aura and other headaches with aura had between a two- and threefold greater prevalence of Rose angina than did those in the no-headache group. More modest increases were also noted in the migraine without aura and the other headache without aura groups compared with the no-headache group." In contrast, there was no higher rate of verified CHD events in any of the headache groups compared with the no-headache group.The study's implications are discussed by Dr Logroscino and Dr Lipton in the same issue of Neurology. They point out that any association between migraine and CHD events would result in the need for greater caution when selecting patients for triptan therapy. They say the lack of any association, plus recent evidence that triptans have a minimal cardiac risk in appropriately selected patients, aids clinical decision-making. "Thus, neurologists should assess and manage vascular risk factors in migraine, exclude silent myocardial ischemia when appropriate, and offer triptan therapy to patients with moderate or severe migraine (US Headache Consortium Guidelines)," they conclude. Reference...