Objective Migraine with visual aura is associated with cardioembolic stroke risk. The aim of this study was to test association between migraine with visual aura and atrial fibrillation (AF), in the Atherosclerosis Risk in Communities study. Methods In the Atherosclerosis Risk in Communities study, a longitudinal, community-based cohort study, participants were interviewed for migraine history in 1993-1995 and were followed for incident AF through 2013. AF was adjudicated using ECGs, discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Mediation analysis was conducted to test whether AF was a mediator of migraine with visual aura-associated stroke risk. Results Of 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraines with visual aura, 1,090 migraine without visual aura, 1,018 nonmigraine headache, and 9,405 no headache. Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1,516 with migraine and 1,623 (17%) of 9,405 without headache. After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache (hazard ratio 1.30, 95% confidence interval 1.03-1.62) as well as when compared to migraine without visual aura (hazard ratio 1.39, 95% confidence interval 1.05-1.83). The data suggest that AF may be a potential mediator of migraine with visual aura-stroke risk. Conclusions Migraine with aura was associated with increased risk of incident AF. This may potentially lead to ischemic strokes.
Bibliographical noteFunding Information:
The Article Processing Charge was funded by the authors.
The Atherosclerosis Risk in Communities Study is conducted as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). Additional funding was provided by American Heart Association grant 16EIA26410001 (A. Alonso).
S. Sen is funded by NIH grants NS062754 and MD009738. X. Androulakis received research support from Tian Medical. V. Duda, A. Alonso, L. Chen, E. Soliman, J. Magnani, T. Trivedi, and A. Merchant report no disclosures relevant to the manuscript. R. Gottesman is Associate Editor for Neuro- logy®. W. Rosamond reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.