Migraine and Cardiovascular Risk in Women

Migraine is a neurovascular headache disorder that affects women disproportionately. Apart from its direct burden, it is a cardiovascular risk factor associated with major cardiovascular events, including stroke, myocardial infarction, arterial dissection, atrial fibrillation, and even cardiovascular mortality. While migraine does not show an obvious association with traditional cardiovascular risk factors or mechanisms, such as obesity, diabetes mellitus, hypertension, and atherosclerosis, exact pathophysiological mechanisms remain elusive. Paradoxically, clinical and epidemiological data show that active migraine is rather associated with favorable risk scores, while pointing towards microvascular dysfunction and an altered neuropeptide activity as a putative biological mechanism. Clear-cut medical therapies and recommendations to mitigate the risk associated with migraine are currently lacking. However, healthy lifestyle modifications are generally recommended, while smoking and the use of combined contraceptives should be discouraged, especially in young females suffering from migraine with aura. In this chapter, we dive into the pathophysiology of the cardiovascular risk associated with migraine and provide clinical directions and implications on the increased cardiovascular risk associated with migraine.