Institute of Public Health, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany.
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Headache Pain. 2020 Mar 17;21(1):27. doi: 10.1186/s10194-020-01091-9.
Migraine carries a high global burden, disproportionately affects women, and has been implicated as a risk factor for cardiovascular disease. Migraine with aura has been consistently associated with increased risk of cardiovascular mortality. However, published evidence on relationships between migraine or non-migraine headache and all-cause mortality is inconclusive. Therefore, we aimed to estimate the effect of non-migraine headache and migraine as well as migraine subtypes on all-cause and cause-specific mortality in women.
In total, 27,844 Women's Health Study participants, aged 45 years or older at baseline, were followed up for a median of 22.7 years. We included participants who provided information on migraine (past history, migraine without aura, or migraine with aura) or headache status and a blood sample at study start. An endpoints committee of physicians evaluated reports of incident deaths and used medical records to confirm deaths due to cardiovascular, cancer, or female-specific cancer causes. We used multivariable Cox proportional hazards models to estimate the effect of migraine or headache status on both all-cause and cause-specific mortality.
Compared to individuals without any headache, no differences in all-cause mortality for individuals suffering from non-migraine headache or any migraine were observed after adjustment for confounding (HR = 1.01, 95%CI, 0.93-1.10 and HR = 0.96, 95% CI: 0.89-1.04). No differences were observed for the migraine subtypes and all-cause death. Women having the migraine with aura subtype had a higher mortality due to cardiovascular disease (adjusted HR = 1.64, 95%CI: 1.06-2.54). As an explanation for the lack of overall association with all-cause mortality, we observed slightly protective signals for any cancer and female-specific cancers in this group.
In this large prospective study of women, we found no association between non-migraine headache or migraine and all-cause mortality. Women suffering from migraine with aura had an increased risk of cardiovascular death. Future studies should investigate the reasons for the increased risk of cardiovascular mortality and evaluate whether changes in migraine patterns across the life course have differential effects on mortality.
偏头痛在全球的负担很高， disproportionately 影响女性，并被认为是心血管疾病的一个风险因素。偏头痛伴先兆一直与心血管死亡率增加有关。然而，关于偏头痛或非偏头痛头痛与全因死亡率之间关系的已发表证据尚无定论。因此，我们旨在估计非偏头痛头痛和偏头痛以及偏头痛亚型对女性全因和特定原因死亡率的影响。
共有 27844 名妇女健康研究参与者，基线时年龄在 45 岁或以上，中位随访时间为 22.7 年。我们纳入了在研究开始时提供偏头痛（既往病史、无先兆偏头痛或有先兆偏头痛）或头痛状况以及血液样本信息的参与者。一个医生组成的终点委员会评估了新发死亡报告，并使用医疗记录确认了心血管、癌症或女性特有的癌症死因导致的死亡。我们使用多变量 Cox 比例风险模型来估计偏头痛或头痛状况对全因和特定原因死亡率的影响。
与没有任何头痛的人相比，在调整混杂因素后，非偏头痛头痛或任何偏头痛患者的全因死亡率没有差异（HR=1.01，95%CI：0.93-1.10 和 HR=0.96，95%CI：0.89-1.04）。偏头痛亚型与全因死亡无差异。患有偏头痛伴先兆亚型的女性因心血管疾病死亡的风险更高（调整后的 HR=1.64，95%CI：1.06-2.54）。作为对总体与全因死亡率无关联的解释，我们在该组中观察到任何癌症和女性特有的癌症的保护信号稍弱。
在这项针对女性的大型前瞻性研究中，我们没有发现非偏头痛头痛或偏头痛与全因死亡率之间的关联。患有偏头痛伴先兆的女性发生心血管死亡的风险增加。未来的研究应调查心血管死亡率增加的原因，并评估整个生命周期偏头痛模式的变化是否对死亡率有不同的影响。
