Relationship between coronary function testing and migraine: results from the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction project

Abstract

Aim: To determine the relationship between coronary vascular dysfunction and history of migraines in women with suspected ischemia and no obstructive coronary arteries (INOCA).

Methods: In the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction study, 402 women with suspected INOCA answered baseline angina questionnaires, including the Seattle Angina Questionnaire (SAQ). Coronary function testing (CFT) performed in a subgroup of 252 women evaluated for nonendothelial and endothelial-dependent coronary vascular function. Wilcoxon rank sum test, t-test, and linear regression models were performed.

Results: Of the 252 women who underwent CFT, 126 (50%) women reported migraine history. Compared to women who reported no migraines, women with migraines were younger and more were premenopausal. They had more angina at rest, with strong emotions, and hot/cold temperatures, as well as angina that wakes them from sleep (P < 0.05 for all). Women with migraines also scored worse on SAQ angina frequency and quality of life (P < 0.01 for both). There was no difference in prevalence of coronary vascular dysfunction in the two groups. In addition, linear regression models demonstrated no significant age-adjusted differences in absolute CFT variables.

Conclusion: Among women with suspected INOCA, migraine history is prevalent and women with migraines have worse angina compared to those without migraines. Coronary vascular dysfunction diagnosed by CFT does not appear to relate to migraine history.

Keywords

Women / coronary microvascular dysfunction / migraines / angina

References

[1] Elgendy IY,Bairey Merz CN.American College of Cardiology Cardiovascular Disease in Women CommitteeAmerican College of Cardiology Cardiovascular Disease in Women CommitteeMigraine headache: an under-appreciated risk factor for cardiovascular disease in women.J Am Heart Assoc2019;8:e014546 PMCID:PMC6915301

[2] Rambarat CA,Johnson BD.Migraine headache and long-term cardiovascular outcomes: an extended follow-up of the Women's Ischemia Syndrome Evaluation.Am J Med2017;130:738-43 PMCID:PMC6419723

[3] Quesada O,Wei J.Design, methodology and baseline characteristics of the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD).Am Heart J2020;220:224-36 PMCID:PMC7147836

[4] Reis SE,Lee JS.Coronary flow velocity response to adenosine characterizes coronary microvascular function in women with chest pain and no obstructive coronary disease.J Am Coll Cardiol1999;33:1469-75

[5] Rose KM,Sanford CP.Migraine and other headaches: associations with Rose angina and coronary heart disease.Neurology2004;63:2233-9

[6] Ahmed B,McClure C.WISE Study GroupMigraines, angiographic coronary artery disease and cardiovascular outcomes in women.Am J Med2006;119:670-5

[7] Merz CN, Pepine CJ, Walsh MN, Fleg JL. Ischemia and no obstructive coronary artery disease (INOCA): developing evidence-based therapies and research agenda for the next decade.Circulation2017;135:1075-92 PMCID:PMC5385930

[8] Miglis MG.Migraine and autonomic dysfunction: which is the horse and which is the jockey?.Curr Pain Headache Rep2018;22:19

[9] Maleki N,Borsook D.Migraine: maladaptive brain responses to stress.Headache2012;52 Suppl 2:102-6 PMCID:PMC3475609

[10] Hoffmann J,Lo H,Reuter U.The influence of weather on migraine - are migraine attacks predictable?.Ann Clin Transl Neurol2015;2:22-8 PMCID:PMC4301671

[11] Seitz A,Pirozzolo G.Long-term follow-up in patients with stable angina and unobstructed coronary arteries undergoing intracoronary acetylcholine testing.JACC Cardiovasc Interv2020;13:1865-76

[12] Aziz A,Sechtem U,Ong P.Sex-related differences in vasomotor function in patients with angina and unobstructed coronary arteries.J Am Coll Cardiol2017;70:2349-58

[13] Schroeder RA,Buse DC.Sex and gender differences in migraine-evaluating knowledge gaps.J Womens Health (Larchmt)2018;27:965-73

[14] MaassenVanDenBrink A,Bax WA,Saxena PR.Coronary side-effect potential of current and prospective antimigraine drugs.Circulation1998;98:25-30