Prevalence and Clinical Factors of Migraine in Patients With Spontaneous Coronary Artery Dissection

Susan N Kok, Sharonne N Hayes, F Michael Cutrer, Claire E Raphael, Rajiv Gulati, Patricia J M Best, Marysia S Tweet, Susan N Kok, Sharonne N Hayes, F Michael Cutrer, Claire E Raphael, Rajiv Gulati, Patricia J M Best, Marysia S Tweet

Abstract

Background Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome predominantly in women without usual cardiovascular risk factors. Many have a history of migraine headaches, but this association is poorly understood. This study aimed to determine migraine prevalence among SCAD patients and assess differences in clinical factors based on migraine history. Methods and Results A cohort study was conducted using the Mayo Clinic SCAD "Virtual" Multi-Center Registry composed of patients with SCAD as confirmed on coronary angiography. Participant-provided data and records were reviewed for migraine history, risk factors, SCAD details, therapies, and outcomes. Among 585 patients (96% women), 236 had migraine history; the lifetime and 1-year prevalence of migraine were 40% and 26%, respectively. Migraine was more common in SCAD women than comparable literature-reported female populations (42% versus 24%, P<0.0001; 42% versus 33%, P<0.0001). Among all SCAD patients, those with migraine history were more likely to be female (99.6% versus 94%; P=0.0002); have SCAD at a younger age (45.2±9.0 years versus 47.6±9.9 years; P=0.0027); have depression (27% versus 17%; P=0.025); have recurrent post-SCAD chest pain at 1 month (50% versus 39%; P=0.035); and, among those assessed, have aneurysms, pseudoaneurysms, or dissections (28% versus 18%; P=0.018). There was no difference in recurrent SCAD at 5 years for those with versus without migraine (15% versus 19%; P=0.39). Conclusions Many SCAD patients have a history of migraine. SCAD patients with migraine are younger at the time of SCAD; have more aneurysms, pseudoaneurysms, and dissections among those imaged; and more often report a history of depression and post-SCAD chest pain. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01429727, NCT01427179.

Keywords: cardiovascular disease; dissection; migraine; myocardial infarction; women.

Figures

Figure 1
Figure 1
Excerpts from SCAD follow‐up questionnaire referencing migraines.
Figure 2
Figure 2
Figure diagramming the frequency of migraine headaches per year among patients with spontaneous coronary artery dissection (SCAD) and active migraine among 231 persons who responded to dedicated migraine survey questions.
Figure 3
Figure 3
Distribution of patients based on age, sex, and migraine status. Spontaneous coronary artery dissection (SCAD) predominantly occurs from 30 to 60 years of age, with SCAD in those with migraine history tending to occur at a younger age compared with patients with SCAD but no migraine headache history. *One man had SCAD and history of migraine; he was age 50 at time of SCAD.
Figure 4
Figure 4
Imaging of vascular abnormalities and recurrent SCAD in a patient with migraine. This 55‐year‐old female's initial spontaneous coronary artery dissection (SCAD) caused an intramural hematoma of the left anterior descending coronary artery (A, arrows); follow‐up coronary angiography demonstrated interval healing (B, arrows). Several years later, she presented with SCAD of the left circumflex with occlusion of the first obtuse marginal, distal circumflex and its branches (C, arrows). Despite an unsuccessful percutaneous intervention attempt, follow‐up coronary angiography showed interval healing (D, arrows). She also was found to have a 7‐mm right periophthalmic cavernous carotid aneurysm (E and F), 3‐mm left cavernous internal carotid artery aneurysm, 2‐ to 3‐mm right cavernous internal carotid aneurysm, and mild fibromuscular dysplasia of the right external iliac artery (G).
Figure 5
Figure 5
5‐year incidence of SCAD recurrence among patients with and without migraine history. No statistically significant difference was found in the Kaplan–Meier survival curve for SCAD patients with migraine (blue line) and that of SCAD patients without migraine (red line) (P=0.39).
Figure 6
Figure 6
Recommendations for management of migraine post‐spontaneous coronary artery dissection (SCAD). This general approach, based on this study's observations, the Mayo Clinic SCAD Clinic experiences, and recommendations from neurology literature, is not meant to be comprehensive and individualization of treatment is required.60, 61, 62, 63 BB indicates β‐blocker; CCB, calcium‐channel blocker; NSAIDs, nonsteroidal anti‐inflammatory drugs.

References

    1. Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian‐Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018;137:e523–e557.
    1. Nakashima T, Noguchi T, Haruta S, Yamamoto Y, Oshima S, Nakao K, Taniguchi Y, Yamaguchi J, Tsuchihashi K, Seki A, Kawasaki T, Uchida T, Omura N, Kikuchi M, Kimura K, Ogawa H, Miyazaki S, Yasuda S. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the angina pectoris‐myocardial infarction multicenter investigators in Japan. Int J Cardiol. 2016;207:341–348.
    1. Nishiguchi T, Tanaka A, Ozaki Y, Taruya A, Fukuda S, Taguchi H, Iwaguro T, Ueno S, Okumoto Y, Akasaka T. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2016;5:263–270.
    1. Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D. Nonatherosclerotic coronary artery disease in young women. Can J Cardiol. 2014;30:814–819.
    1. Tweet MS, Gulati R, Hayes SN. Spontaneous coronary artery dissection. Curr Cardiol Rep. 2016;18:60.
    1. Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D, Robinson S, Vuurmans T, Gao M, Humphries K, Mancini GB. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7:645–655.
    1. Tweet MS, Gulati R, Aase LA, Hayes SN. Spontaneous coronary artery dissection: a disease‐specific, social networking community‐initiated study. Mayo Clin Proc. 2011;86:845–850.
    1. Tweet MS, Gulati R, Williamson EE, Vrtiska TJ, Hayes SN. Multimodality imaging for spontaneous coronary artery dissection in women. JACC Cardiovasc Imaging. 2016;9:436–450.
    1. Eleid MF, Guddeti RR, Tweet MS, Lerman A, Singh M, Best PJ, Vrtiska TJ, Prasad M, Rihal CS, Hayes SN, Gulati R. Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications. Circ Cardiovasc Interv. 2014;7:656–662.
    1. Henkin S, Negrotto SM, Tweet MS, Kirmani S, Deyle DR, Gulati R, Olson TM, Hayes SN. Spontaneous coronary artery dissection and its association with heritable connective tissue disorders. Heart. 2016;102:876–881.
    1. Prasad M, Tweet MS, Hayes SN, Leng S, Liang JJ, Eleid MF, Gulati R, Vrtiska TJ. Prevalence of extracoronary vascular abnormalities and fibromuscular dysplasia in patients with spontaneous coronary artery dissection. Am J Cardiol. 2015;115:1672–1677.
    1. Tweet MS, Hayes SN, Codsi E, Gulati R, Rose CH, Best PJM. Spontaneous coronary artery dissection associated with pregnancy. J Am Coll Cardiol. 2017;70:426–435.
    1. McGrath‐Cadell L, McKenzie P, Emmanuel S, Muller DW, Graham RM, Holloway CJ. Outcomes of patients with spontaneous coronary artery dissection. Open Heart. 2016;3:e000491.
    1. Ahmed B, Bairey Merz CN, McClure C, Johnson BD, Reis SE, Bittner V, Pepine CJ, Sharaf BL, Sopko G, Kelsey SF, Shaw L. Migraines, angiographic coronary artery disease and cardiovascular outcomes in women. Am J Med. 2006;119:670–675.
    1. Bigal ME, Lipton RB, Stewart WF. The epidemiology and impact of migraine. Curr Neurol Neurosci Rep. 2004;4:98–104.
    1. Launer LJ, Terwindt GM, Ferrari MD. The prevalence and characteristics of migraine in a population‐based cohort: the GEM study. Neurology. 1999;53:537–542.
    1. Kurth T, Winter AC, Eliassen AH, Dushkes R, Mukamal KJ, Rimm EB, Willett WC, Manson JE, Rexrode KM. Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ. 2016;353:i2610.
    1. Linstra KM, Ibrahimi K, Terwindt GM, Wermer MJ, MaassenVanDenBrink A. Migraine and cardiovascular disease in women. Maturitas. 2017;97:28–31.
    1. Rambarat CA, Elgendy IY, Johnson BD, Reis SE, Thompson DV, Sharaf BL, Bittner V, Sopko G, Bairey Merz CN, Pepine CJ, Ahmed B. Migraine headache and long‐term cardiovascular outcomes: an extended follow‐up of the women's ischemia syndrome evaluation. Am J Med. 2017;130:738–743.
    1. Sacco S, Ornello R, Ripa P, Tiseo C, Degan D, Pistoia F, Carolei A. Migraine and risk of ischaemic heart disease: a systematic review and meta‐analysis of observational studies. Eur J Neurol. 2015;22:1001–1011.
    1. De Giuli V, Grassi M, Lodigiani C, Patella R, Zedde M, Gandolfo C, Zini A, DeLodovici ML, Paciaroni M, Del Sette M, Azzini C, Toriello A, Musolino R, Calabro RS, Bovi P, Sessa M, Adami A, Silvestrelli G, Cavallini A, Marcheselli S, Bonifati DM, Checcarelli N, Tancredi L, Chiti A, Lotti EM, Del Zotto E, Tomelleri G, Spalloni A, Giorli E, Costa P, Poli L, Morotti A, Caria F, Lanari A, Giacalone G, Ferrazzi P, Giossi A, Piras V, Massucco D, D'Amore C, Di Lisi F, Casetta I, Cucurachi L, Cotroneo M, De Vito A, Coloberti E, Rasura M, Simone AM, Gamba M, Cerrato P, Micieli G, Malferrari G, Melis M, Iacoviello L, Padovani A, Pezzini A. Association between migraine and cervical artery dissection: the Italian project on stroke in young adults. JAMA Neurol. 2017;74:512–518.
    1. Lebedeva ER, Gurary NM, Sakovich VP, Olesen J. Migraine before rupture of intracranial aneurysms. J Headache Pain. 2013;14:15.
    1. Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH, Jaff MR, Kim ES, Mace P, Matsumoto AH, McBane RD, Kline‐Rogers E, White CJ, Gornik HL. The United States registry for fibromuscular dysplasia: results in the first 447 patients. Circulation. 2012;125:3182–3190.
    1. Zhou M, Zheng H, Gong S, Guo J, Chen N, Zhou D, Yang R, Zhu C, He L. Vertebral artery hypoplasia and vertebral artery dissection: a hospital‐based cohort study. Neurology. 2015;84:818–824.
    1. Goel K, Tweet M, Olson TM, Maleszewski JJ, Gulati R, Hayes SN. Familial spontaneous coronary artery dissection: evidence for genetic susceptibility. JAMA Intern Med. 2015;175:821–826.
    1. Headache Classification Committee of the International Headache Society (IHS) . The International Classification of Headache Disorders 3rd edition (beta version). Cephalalgia. 2013;33:629–808.
    1. Buse DC, Loder EW, Gorman JA, Stewart WF, Reed ML, Fanning KM, Serrano D, Lipton RB. Sex differences in the prevalence, symptoms, and associated features of migraine, probable migraine and other severe headache: results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2013;53:1278–1299.
    1. Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener HC, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA. 2006;296:283–291.
    1. Liang JJ, Prasad M, Tweet MS, Hayes SN, Gulati R, Breen JF, Leng S, Vrtiska TJ. A novel application of CT angiography to detect extracoronary vascular abnormalities in patients with spontaneous coronary artery dissection. J Cardiovasc Comput Tomogr. 2014;8:189–197.
    1. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence‐based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1346–1353.
    1. Saw J, Humphries K, Aymong E, Sedlak T, Prakash R, Starovoytov A, Mancini GBJ. Spontaneous coronary artery dissection: clinical outcomes and risk of recurrence. J Am Coll Cardiol. 2017;70:1148–1158.
    1. Mawet J, Debette S, Bousser MG, Ducros A. The link between migraine, reversible cerebral vasoconstriction syndrome and cervical artery dissection. Headache. 2016;56:645–656.
    1. Rose KM, Wong TY, Carson AP, Couper DJ, Klein R, Sharrett AR. Migraine and retinal microvascular abnormalities: the atherosclerosis risk in communities study. Neurology. 2007;68:1694–1700.
    1. Sacco S, Ricci S, Carolei A. Migraine and vascular diseases: a review of the evidence and potential implications for management. Cephalalgia. 2012;32:785–795.
    1. Schillaci G, Sarchielli P, Corbelli I, Pucci G, Settimi L, Mannarino MR, Calabresi P, Mannarino E. Aortic stiffness and pulse wave reflection in young subjects with migraine: a case‐control study. Neurology. 2010;75:960–966.
    1. Mawet J, Kurth T, Ayata C. Migraine and stroke: in search of shared mechanisms. Cephalalgia. 2015;35:165–181.
    1. Tzourio C, El Amrani M, Robert L, Alperovitch A. Serum elastase activity is elevated in migraine. Ann Neurol. 2000;47:648–651.
    1. Metso TM, Tatlisumak T, Debette S, Dallongeville J, Engelter ST, Lyrer PA, Thijs V, Bersano A, Abboud S, Leys D, Grond‐Ginsbach C, Kloss M, Touze E, Pezzini A, Metso AJ. Migraine in cervical artery dissection and ischemic stroke patients. Neurology. 2012;78:1221–1228.
    1. Tietjen GE. Migraine as a systemic vasculopathy. Cephalalgia. 2009;29:987–996.
    1. González‐Quintanilla V, Toriello M, Palacio E, González‐Gay MA, Castillo J, Montes S, Martínez‐Nieto R, Fernandez J, Rojo A, Gutiérrez S, Pons E, Oterino A. Systemic and cerebral endothelial dysfunction in chronic migraine. A case‐control study with an active comparator. Cephalalgia. 2016;36:552–560.
    1. Gormley P, Anttila V, Winsvold BS, Palta P, Esko T, Pers TH, Farh KH, Cuenca‐Leon E, Muona M, Furlotte NA, Kurth T, Ingason A, McMahon G, Ligthart L, Terwindt GM, Kallela M, Freilinger TM, Ran C, Gordon SG, Stam AH, Steinberg S, Borck G, Koiranen M, Quaye L, Adams HH, Lehtimaki T, Sarin AP, Wedenoja J, Hinds DA, Buring JE, Schurks M, Ridker PM, Hrafnsdottir MG, Stefansson H, Ring SM, Hottenga JJ, Penninx BW, Farkkila M, Artto V, Kaunisto M, Vepsalainen S, Malik R, Heath AC, Madden PA, Martin NG, Montgomery GW, Kurki MI, Kals M, Magi R, Parn K, Hamalainen E, Huang H, Byrnes AE, Franke L, Huang J, Stergiakouli E, Lee PH, Sandor C, Webber C, Cader Z, Muller‐Myhsok B, Schreiber S, Meitinger T, Eriksson JG, Salomaa V, Heikkila K, Loehrer E, Uitterlinden AG, Hofman A, van Duijn CM, Cherkas L, Pedersen LM, Stubhaug A, Nielsen CS, Mannikko M, Mihailov E, Milani L, Gobel H, Esserlind AL, Christensen AF, Hansen TF, Werge T, Kaprio J, Aromaa AJ, Raitakari O, Ikram MA, Spector T, Jarvelin MR, Metspalu A, Kubisch C, Strachan DP, Ferrari MD, Belin AC, Dichgans M, Wessman M, van den Maagdenberg AM, Zwart JA, Boomsma DI, Smith GD, Stefansson K, Eriksson N, Daly MJ, Neale BM, Olesen J, Chasman DI, Nyholt DR, Palotie A. Meta‐analysis of 375,000 individuals identifies 38 susceptibility loci for migraine. Nat Genet. 2016;48:856–866.
    1. Kiando SR, Tucker NR, Castro‐Vega LJ, Katz A, D'Escamard V, Treard C, Fraher D, Albuisson J, Kadian‐Dodov D, Ye Z, Austin E, Yang ML, Hunker K, Barlassina C, Cusi D, Galan P, Empana JP, Jouven X, Gimenez‐Roqueplo AP, Bruneval P, Hyun Kim ES, Olin JW, Gornik HL, Azizi M, Plouin PF, Ellinor PT, Kullo IJ, Milan DJ, Ganesh SK, Boutouyrie P, Kovacic JC, Jeunemaitre X, Bouatia‐Naji N. PHACTR1 is a genetic susceptibility locus for fibromuscular dysplasia supporting its complex genetic pattern of inheritance. PLoS Genet. 2016;12:e1006367.
    1. Pezzini A, Del Zotto E, Giossi A, Volonghi I, Grassi M, Padovani A. The migraine‐ischemic stroke connection: potential pathogenic mechanisms. Curr Mol Med. 2009;9:215–226.
    1. MacGregor EA. Migraine headache in perimenopausal and menopausal women. Curr Pain Headache Rep. 2009;13:399–403.
    1. Martin VT, Lipton RB. Epidemiology and biology of menstrual migraine. Headache. 2008;48(suppl 3):S124–S130.
    1. Mathew PG, Dun EC, Luo JJ. A cyclic pain: the pathophysiology and treatment of menstrual migraine. Obstet Gynecol Surv. 2013;68:130–140.
    1. Stewart WF, Lipton RB, Chee E, Sawyer J, Silberstein SD. Menstrual cycle and headache in a population sample of migraineurs. Neurology. 2000;55:1517–1523.
    1. Tweet MS, Codsi E, Best PJM, Gulati R, Rose CH, Hayes SN. Menstrual chest pain in women with history of spontaneous coronary artery dissection. J Am Coll Cardiol. 2017;70:2308–2309.
    1. Calhoun AH. Hormonal contraceptives and migraine with aura‐is there still a risk? Headache. 2017;57:184–193.
    1. Silberstein S, Patel S. Menstrual migraine: an updated review on hormonal causes, prophylaxis and treatment. Expert Opin Pharmacother. 2014;15:2063–2070.
    1. Miller VM, Duckles SP. Vascular actions of estrogens: functional implications. Pharmacol Rev. 2008;60:210–241.
    1. de Tommaso M, Sciruicchio V. Migraine and central sensitization: clinical features, main comorbidities and therapeutic perspectives. Curr Rheumatol Rev. 2016;12:113–126.
    1. Palacios‐Cena M, Lima Florencio L, Natalia Ferracini G, Baron J, Guerrero AL, Ordas‐Bandera C, Arendt‐Nielsen L, Fernandez‐de‐Las‐Penas C. Women with chronic and episodic migraine exhibit similar widespread pressure pain sensitivity. Pain Med. 2016;17:2127–2133.
    1. Shaw J, Anderson T. Coronary endothelial dysfunction in non‐obstructive coronary artery disease: risk, pathogenesis, diagnosis and therapy. Vasc Med. 2016;21:146–155.
    1. Liang JJ, Tweet MS, Hayes SE, Gulati R, Hayes SN. Prevalence and predictors of depression and anxiety among survivors of myocardial infarction due to spontaneous coronary artery dissection. J Cardiopulm Rehabil Prev. 2014;34:138–142.
    1. Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A. Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain. 2011;12:115–125.
    1. Seng EK, Buse DC, Klepper JE, S JM, Grinberg AS, Grosberg BM, Pavlovic JM, Robbins MS, Vollbracht SE, Lipton RB. Psychological factors associated with chronic migraine and severe migraine‐related disability: an observational study in a tertiary headache center. Headache. 2017;57:593–604.
    1. Cohen BE, Edmondson D, Kronish IM. State of the art review: depression, stress, anxiety, and cardiovascular disease. Am J Hypertens. 2015;28:1295–1302.
    1. Garcia Garcia C, Casanovas N, Recasens L, Miranda F, Bruguera J. Spontaneous coronary artery dissection in ergotamine abuse. Int J Cardiol. 2007;118:410–411.
    1. Becker WJ. Acute migraine treatment in adults. Headache. 2015;55:778–793.
    1. Diener HC, Kurth T, Holle D. Practical implications of the migraine cardio‐ and cerebrovascular association: unmet needs of patients. Cephalalgia. 2015;35:140–145.
    1. Hill SE, Kirsten L. Triptan‐induced torsades de pointes and ventricular fibrillation cardiac arrest: case report and review of the literature. Curr Drug Saf. 2014;9:236–239.
    1. Pringsheim T, Davenport WJ, Marmura MJ, Schwedt TJ, Silberstein S. How to apply the AHS evidence assessment of the acute treatment of migraine in adults to your patient with migraine. Headache. 2016;56:1194–1200.
    1. Artto V, Metso TM, Metso AJ, Putaala J, Haapaniemi E, Wessman M, Farkkila M, Kallela M, Tatlisumak T. Migraine with aura is a risk factor for cervical artery dissection: a case‐control study. Cerebrovasc Dis. 2010;30:36–40.
    1. Schurks M, Buring JE, Kurth T. Agreement of self‐reported migraine with ICHD‐II criteria in the women's health study. Cephalalgia. 2009;29:1086–1090.
    1. Dodick DW, Loder EW, Manack Adams A, Buse DC, Fanning KM, Reed ML, Lipton RB. Assessing barriers to chronic migraine consultation, diagnosis, and treatment: results from the chronic migraine epidemiology and outcomes (CAMEO) study. Headache. 2016;56:821–834.
    1. Lipton RB, Diamond S, Reed M, Diamond ML, Stewart WF. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache. 2001;41:638–645.
    1. Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine and cardiovascular disease: systematic review and meta‐analysis. BMJ. 2009;339:b3914.
    1. Mahmoud AN, Mentias A, Elgendy AY, Qazi A, Barakat AF, Saad M, Mohsen A, Abuzaid A, Mansoor H, Mojadidi MK, Elgendy IY. Migraine and the risk of cardiovascular and cerebrovascular events: a meta‐analysis of 16 cohort studies including 1 152 407 subjects. BMJ Open. 2018;8:e020498.
    1. Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, Gray WA, Gupta R, Hamburg NM, Katzen BT, Lookstein RA, Lumsden AB, Newburger JW, Rundek T, Sperati CJ, Stanley JC. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation. 2014;129:1048–1078.

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