Importance
A previous cohort study in the United States found that females with higher cardiovascular risk were more likely to have a history of migraine but less likely to have active migraine. Extrapolating these results to men and European individuals is uncertain yet crucial to understanding the complex relationship between migraine activity status and vascular health.
Objective
To evaluate the predictive association pattern between two cardiovascular risk scores, the most recent European version of the Systematic COronary Risk Evaluation 2 (SCORE2) risk estimation system and the Framingham Risk Score (FRS), and migraine activity status in Dutch men and women.
Design, Setting, and Participants
Community-dwelling adults residing in the northern part of the Netherlands in Lifelines – a prospective population-based cohort study. Individuals with a terminal illness, (incapacitated) individuals with a severe mental illness, and individuals who were unable to visit their general practitioner or complete the questionnaires were excluded from participation within Lifelines. We only included participants whose data on the cardiovascular risk scores and migraine status were complete.
Cross-sectional and follow-up analysesAnalyses were conducted within the prospective Lifelines cohort, and baseline characteristics were collected between 2006–2014. Questionnaires were sent approximately every 1.5–2.5 years, and the last self-reported migraine assessment took place between 2019–2021.
Setting
in the northern part of the Netherlands.
Participants
Individuals with a terminal illness, (incapacitated) individuals with a severe mental illness, and individuals who were unable to visit their general practitioner or complete the questionnaires were excluded from participation within Lifelines. We only included participants whose data on the cardiovascular risk scores and migraine status were complete.
Exposure(s)
The SCORE2FRS is a sex-specific European cardiovascular risk score that includes including age, cholesterol levels, smoking, antihypertensive drug use, diabetes mellitus, and systolic blood pressure. SCORE2 risk scores were measured once at baseline. The SCORE2 is a European version that requires similar variables, except for antihypertensive drug use.
Main Outcome(s) and Measure(s)
Migraine activity status was assessed using self-reported questionnaires and classified as (i) prevalent migraine (i.e., migraine at baseline), (ii) incident migraine (i.e., no migraine at baseline but migraine in at least one follow-up), and (iii) no migraine.
Results
The total study population consisted of 140,915 individuals at baseline with a mean age of 44.4 (SD = 12.7) years, of whom 58.5% were women. In total, 25,915 individuals (18.4% of the total population) had prevalent migraine and 2,224 participants (1.9% of the total population with/without incident migraine) had incident migraine. The odds of the probability of having prevalent and incident migraine, compared with individuals with a SCORE2 or FRS category <1%, vary and decrease with increasing SCORE2 categories with odds ratios (ORs) ranging from 0.93–0.43 for prevalent migraine and 0.63–0.17 for incident migraine. Comparable results were obtained for FRS categories with ORs ranging from 1.29–0.76 for prevalent migraine and 0.92–0.27 for incident migraine. A similar pattern was observed in both sexes but more profound in women. Indeed, in women, ORs ranged from 1.21–0.70 for prevalent migraine (versus 1.19–0.84 in men) and 0.72–0.20 for incident migraine (versus 1.18–0.44 in men). Moreover, models with incident migraine as the outcome showed lower ORs across the ascending cardiovascular risk score categories.
Conclusions and Relevance
In this Dutch cohort study of community-dwelling adults, the odds of having prevalent or incident migraine decreased with increasing risk score categories. TheseOur results substantiate the hypothesis that a relatively healthy cardiovascular system increases the probability of having active or developing migraine in the future, especially among women. Sex and gender differences might play a pathophysiological role in the association between migraine activity and vascular health.