The term “migraine” comes from the Greek “hemicranias” — meaning “half of the head.” What a fitting term, since severe pain on one side of the head is a striking symptom experienced by many suffering from this debilitating disorder. But migraines can also affect other parts of the body, and have even been correlated with cardiovascular disease (CVD). In this article, we’ll detail the different types of migraines and what causes them, as well as the link between migraine headaches and heart disease — including some interesting results from genetic studies.

What are the classifications of migraines?

Migraines are primary headaches, meaning they are not caused by another medical condition. They can occur in either episodic (fewer than 15 days a month) or chronic (15 or more days a month for three consecutive months) forms, and can be classified into two main categories:

Migraine with aura (MA). Aura can be thought of as a warning signal that precedes a migraine. Aura symptoms can be prevented or healed, and include:

• Seeing bright spots or having blind spots
• Ringing in the ears (tinnitus)
• Changes in taste or smell
• Numb or tingly skin
• Speech changes
  

Migraine without aura (MO). This type of migraine occurs without warning, since there is no preceding aura. Also called the “common migraine,” an estimated 80-85% of people with migraine headaches do not have aura symptoms.

In addition, migraines typically progress through four stages, although not everyone experiences all four:

1. Prodrome – the warning phase. Prodrome consists of subtle changes in mood, food cravings, bowel movements, and neck stiffness.
2. Aura – can occur before or during migraines and can last for about an hour.
3. Attack – lasts between 4-72 hours and consists of photosensitivity (sensitivity to light), phonosensitivity (sensitivity to sound), nausea, and vomiting.
4. Postdrome – the end phase. Postdrome might cause a person to feel drained, exhausted, confused, or even happy that the migraine is over.

All of these characteristics highlight the debilitating nature of migraines. With a better understanding of these stages and features, we can better predict how migraines arise and what affected people can do to reduce the frequency and duration of them.

What can genetics tell us about migraines?

There are many factors that can trigger migraines, including diet, lifestyle, and physiological and biochemical factors. But perhaps the most intriguing are genetic factors, which can also help explain why migraines affect women more than men and are correlated with other conditions, such as CVD. One of the strongest clues suggesting a genetic component for migraines is the percentage of cases indicating migraine heritability.

Results from multiple studies indicate that migraine-associated genes can be sorted into three categories:

• Neuronal
• Vascular 
• Oxidative stress

Additionally, a recent genome-wide association study of over 100,000 migraine cases identified over 100 genetic loci, allowing researchers to study both the similarities and differences between MA and MO. Similar to other studies, the results indicated genetic enrichment in both vascular and nervous cell types, providing further evidence supporting the neurovascular underpinnings of migraines. This is particularly interesting because of the interplay between the nervous and cardiovascular systems in the brain. Fun fact: if you are familiar with 23andMe, a company invested in DNA-powered health, then you might be interested to learn that 23andMe data contributed to these findings. 

Migraine headaches, heart disease and CVD

In the past couple of decades, research has found an increased association between migraines and cardiovascular disease, particularly among women. Although the clinical importance of this association is still under investigation, multiple studies have shown that people with MA are more likely to have CVD than people with MO. One example of this is with ischemic stroke (obstruction of a blood vessel in the brain), where MA was found to be more common compared with MO in female patients. In addition, the 2017 American Migraine Prevalence and Prevention modeling study predicts that people over 40 years old with episodic migraines are at increased risk for a cardiovascular event within the next 10 years.

Why the association between migraine headaches and heart disease like CVD? The short answer is that no one knows for certain (as of now), mainly because it is difficult to tease apart the mechanistic links between the two. However, studies addressing this link suggest the following top possible reasons:

• Hormones – Circulating levels of hormones such as estrogen are associated with changes in cerebral vasculature related to cardiovascular disease and migraines.
• Gender – Women are more likely than men to have migraines, experiencing increased risk factors such as systemic inflammation that can lead to cardiovascular disease.‍
• Genetics – As mentioned above, certain genetic risk factors exist that may explain the link between migraines and cardiovascular disease.‍
• Endothelial dysfunction – Although research is sparse, endothelial biomarkers are increased in MA patients, which may be associated with an increased risk of ischemic stroke.‍
• Patent foramen ovale (PFO) – PFO is an opening between the atria of the heart, and the majority of patients who have migraines and experience a stroke have a high prevalence of PFO.

Genome-wide studies have identified shared genetic risk between migraine and coronary artery disease, highlighting a need to further study genetic links between migraine headaches, heart disease and cardiovascular disease. Understanding the genetics could help identify treatments that may alleviate both migraine and CVD.

How to prevent migraines

If any of this sounds horrible, there are things that can be done to help reduce or manage migraines, which may also reduce CVD symptoms and risk. Some of these methods may work better for some people and not others, and it’s important to note that attempting to reduce migraines is a highly individualized endeavor. That being said, here are some strategies that may help improve quality of life for those suffering from migraines:

• Practice mindfulness: Managing stress through mindfulness can be as effective as certain medications for reducing migraine frequency and pain intensity. Additionally, establishing good sleep hygiene, finding time to relax, and keeping a positive attitude can all help manage stress and lower migraine prevalence.
  
• Change your diet: The gastrointestinal system is intricately linked to the nervous system, and studies examining the effects of certain diets on migraine progression have yielded positive results. Ketogenic, Mediterranean, and low glycemic diets may be good options due to their neuroprotective and potentially anti-inflammatory effects, which may have benefits related to CVD risk. A more recent and intriguing diet is the so-called “epigenetic diet,” in which specific foods or compounds are consumed to supposedly target specific epigenetic modifications such as DNA methylation, which plays a critical role in gene transcription. It’s important to note that research in this area is relatively new and additional studies are needed.
  
• Exercise regularly: Although acute exercise can trigger migraines, there is evidence that regular exercise may serve a preventative role, reducing frequency and duration of migraines. Interestingly, there appears to be no difference between aerobic and strength training. But the common factor in these studies is that the exercise has to be ongoing to take advantage of the preventative benefits. Although it is not definitively known why regular exercise benefits individuals with migraines, several studies implicate the effects of exercise on the endogenous opioid and endocannabinoid systems, possibly through the release of endorphins — which can produce an analgesic effect.
  
• Take medicine: In some cases, your healthcare provider might determine that medications are necessary to help control your migraines. The two main types of medications for migraines are abortive and preventative. Abortive medications are taken at the first sign of a migraine. They stop the progression of headaches, nausea, and sensitivity by constricting blood vessels, which may also relieve throbbing pain. Preventive or prophylactic medications are taken when the pain is more severe and interferes with everyday activities. Some potential mechanisms of action for preventative medications include suppressing excitatory neural signaling and reducing neural sensitivity to stimuli. Any medications should be taken only under the direction of your healthcare provider.
  
• Combine therapies: The aforementioned strategies may work on their own, but combining them may lead to an even greater reduction in migraine symptoms and progression. 

Many of these strategies and practices not only prove efficacious for managing migraines, but in turn have a positive effect on the cardiovascular system. For example, the benefits of intentional mindfulness on cardiovascular health have been extensively studied. The Mediterranean diet yields several health benefits, including cardioprotective effects. And exercise, of course, improves cardiovascular fitness and reduces the risk for CVD. 

Be sure to work with your medical team before embarking on any new dietary, exercise, or medication regimens, as your providers will be able to help you find the safest, most effective combination of therapies and practices to help reduce migraines and improve your cardiovascular health.

Key takeaways

Migraines are literally a pain to deal with and can be debilitating. Because they often “come out of nowhere,” with seemingly no explanation for their onset, it’s natural to feel frustrated. In addition, migraines are correlated with the onset of CVD, although the mechanisms mediating that relationship require further study. While it remains difficult to pinpoint the causes of migraine headaches, strategies for reducing the risk of migraines and managing them do exist — and many of these practices also improve cardiovascular health. Your healthcare provider can help you find the right balance of lifestyle and, if deemed necessary, medicinal interventions to manage your migraines, improve your cardiovascular health, and enjoy a healthier, pain-free life.