As there are several shared risk and factors and mechanisms between migraines and abdominal aortic aneurysm (AAA), investigators from Taiwan set out to examine whether patients with migraine could have an increased risk of AAA.
Hypertension, hyperlipidemia and smoking are risk factors for both AAA and migraine, wrote Lin Jou-Yu, with Cheng Hsin General Hospital in Tapei, Taiwan and colleagues in a recent International Journal of Environmental Research and Public Health article.
“Activated matrix metalloproteinases (MMPs), endothelial dysfunction and vascular inflammation also overlap in the disease pathogenesis of AAA and migraine. However, there has been limited research regarding the association between migraine and AAA,” the investigators wrote.
Utilizing the National Health Insurance Research Database (NHIRD), the investigators selected patient and control cohorts by 1:4 matching according to age, sex, and comorbidities, including hypertension, diabetes, hyperlipidemia, acute ischemic stroke, intracerebral hemorrhage, coronary artery disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and cancer.
They also recorded patients’ long-term medications associated with the treatment of migraine or AAA. These treatments included:
- Antihypertensive agents,
- calcium channel blockers,
- diuretics and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers,
- selective serotonin agonists,
- and anti-migraine agents such as ergot alkaloids, topiramate, valproate, tricyclic antidepressants, selective serotonin reuptake inhibitors, and flunarizine.
The investigators also tracked nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesic drugs other than NSAIDs, including aspirin, acetaminophen and cyclooxygenase-2 inhibitors.
The results demonstrated that patients with migraine had a significantly higher cumulative risk of developing AAA 5 years after the index date compared with the patients without migraine. At the end of the 15-year follow-up period, a significantly higher incidence of AAA (0.98% vs 0.24%) and several comorbidities, including hypertension, hyperlipidemia, COPD, and malignancies, were observed in the patients with migraine compared with those without migraine. In addition, males with migraine had a nearly 6-fold increased risk of AAA compared with females without migraine.
“We therefore propose that male patients with migraine should undergo additional screening examinations for AAA,” the investigators wrote.
Patients with migraine with aura were also more likely to develop AAA than patients who had migraine without aura. However, there were no differences regarding the use of cardiovascular medications, antimigraine medications, NSAIDs, or flunarizine at the end of the study.
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1. Lin JY, Tung CS, et al. The association between migraine and abdominal aortic aneurysms: A nationwide population-based cohort study. Int J Environ Res Public Health. April 20, 2021. doi:10.3390/ijerph18084389.