Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH 45401-0927, USA.
Headache. 2011 Feb;51(2):331-7. doi: 10.1111/j.1526-4610.2010.01839.x.
There have been associations demonstrated between migraine and ischemic stroke and heart disease. Additionally, headache patients have increased cardiovascular risk factors. This article reviews available data supporting these concerns and answers the following questions: 1) Does the association between migraine and cardiovascular disease warrant cardiovascular screening tests in migraine sufferers? There is enough observational data to conclude that migraine with aura is a risk factor for cardiovascular disease. With the available data, we cannot recommend any additional cardiovascular screening tests for migraine patients. 2) Are there specific risk modification approaches for headache patients? As there is no data to suggest that migraine is a modifiable risk factor, no additional cardiovascular interventions beyond the standard practice of treating modifiable risk factors are suggested for migraine sufferers. 3) What is the appropriate screening for patients who may be candidates for triptans or tricyclic antidepressants? We support screening headache patients by obtaining a history of prior cardiovascular disease and traditional cardiovascular disease risk factors. We have found no data to suggest that any non-invasive cardiovascular screening test will identify a population of migraine sufferers at high risk for cardiovascular events following triptan use. Due to the increased risk of cardiovascular toxicity, ECGs should be considered prior to initiating tricyclic antidepressants in patients with preexisting cardiovascular disease.
已经有研究表明偏头痛与缺血性中风和心脏病之间存在关联。此外，头痛患者存在更多心血管危险因素。本文综述了支持这些关联的现有数据，并回答了以下问题：1）偏头痛与心血管疾病之间的关联是否需要在偏头痛患者中进行心血管筛查测试？有足够的观察数据表明，有先兆的偏头痛是心血管疾病的一个危险因素。根据现有数据，我们不能建议对偏头痛患者进行任何额外的心血管筛查测试。2）对于头痛患者，是否有特定的风险降低方法？由于没有数据表明偏头痛是可改变的危险因素，因此除了治疗可改变的危险因素的标准方法之外，不建议对偏头痛患者进行其他心血管干预。3）对于可能成为曲坦类药物或三环类抗抑郁药候选者的患者，适当的筛查方法是什么？我们支持通过获取既往心血管疾病和传统心血管疾病危险因素的病史来筛查头痛患者。我们没有发现任何数据表明任何非侵入性心血管筛查测试将识别出使用曲坦类药物后发生心血管事件风险较高的偏头痛患者群体。由于心血管毒性风险增加，对于有既往心血管疾病的患者，在开始使用三环类抗抑郁药之前应考虑进行心电图检查。
