The Role of Cardiovascular Screening in Headache Patients

Authors

  • Karen E. Kirkham MD,

    1. From the Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA (K.E. Kirkham, M.R.J. Colon, and G.D. Solomon); US Air Force Medical Center, Wright-Patterson, Wright-Patterson AFB, OH, USA (M.R.J. Colon).
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  • Major Roberto J. Colon MD,

    1. From the Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA (K.E. Kirkham, M.R.J. Colon, and G.D. Solomon); US Air Force Medical Center, Wright-Patterson, Wright-Patterson AFB, OH, USA (M.R.J. Colon).
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  • Glen D. Solomon MD

    1. From the Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA (K.E. Kirkham, M.R.J. Colon, and G.D. Solomon); US Air Force Medical Center, Wright-Patterson, Wright-Patterson AFB, OH, USA (M.R.J. Colon).
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  • Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Air Force, Department of Defense, or the US government.

  • Conflict of Interest: None

G.D. Solomon, Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, P.O. Box 927, Dayton, OH 45401-0927, USA.

Abstract

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.

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