Association between migraine and cardiovascular disease mortality: A prospective population‐based cohort study

Abstract Objective The study assessed the association between migraine and cardiovascular disease (CVD) mortality in the US population. Background Previous studies have drawn different conclusions about the association between migraine and CVD mortality based on different populations; therefore, it is important to explore the relationship between migraine and CVD mortality in the US population. Methods This prospective cohort study included 10,644 participants from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Participants who reported having severe headache or migraine were classified as having migraine. Mortality data were obtained by linkage of the cohort database to the National Death Index as of December 31, 2019. Based on the International Classification of Diseases, Tenth Revision, CVD mortality includes the following disease codes: I00–I09 (acute rheumatic fever and chronic rheumatic heart diseases), I11 (hypertensive heart disease), I13 (hypertensive heart and renal disease), I20–I25 (ischemic heart diseases), I26–I28 (pulmonary embolism and other acute pulmonary heart diseases), I29 (various cardiovascular diseases caused by different reasons), I30–I51 (other forms of heart disease), and I60–I69 (cerebrovascular diseases). Data were analyzed from October to November 2022. Results Among 10,644 adults included in the study (mean age, 46.4 [0.3] years, 5430 men [47.4%]), 2106 (20.4%) had migraine. During a median follow‐up period of 201 months, there were 3078 all‐cause deaths and 997 CVD deaths. Compared to individuals without migraine, those with migraine had an adjusted hazard ratio (HR) of 1.30 (95% confidence interval [CI], 1.04–1.62; p = 0.019) for CVD mortality and 1.23 (95% CI, 1.13–1.35; p < 0.001) for all‐cause mortality. In subgroup analyses, migraine was associated with CVD mortality in participants who were women (HR, 1.43; 95% CI, 1.06–1.93), aged < 45 years (HR, 1.69; 95% CI, 1.04–2.76), non‐Hispanic White (HR, 1.42; 95% CI, 1.09–1.86), those with a body mass index < 30 kg/m 2 (HR, 1.36; 95% CI, 1.03–1.78), former or current smokers (HR, 1.36; 95% CI, 1.00–1.85), former or current alcohol drinkers (HR, 1.33; 95% CI, 1.03–1.72), and those without metabolic syndrome (HR, 1.31; 95% CI, 1.01–1.71). The association between migraine and CVD mortality was robust in sensitivity analyses, after excluding participants who died within 2 years of follow‐up (HR, 1.31; 95% CI, 1.05–1.65) or those with a history of cancer at baseline (HR, 1.28; 95% CI, 1.01–1.62). Conclusions Migraine was associated with a higher CVD mortality rate in the US population.