A recent study by Dr. Bigal and his colleagues just published in Neurology compared more than 6,000 migraine sufferers with over 5,000 matched control subjects without migraines. They discovered that people with migraine with aura and to a lesser extent those with migraine without aura are significantly more likely to have strokes, heart attacks, hypertension, poor circulation, diabetes, and high cholesterol. This clearly does not mean that migraine causes all these diseases, but only that if you have one you are more likely to have the other. It is important to recognize this association in migraine sufferers in order to regularly screen them for these conditions. We know that controlling diabetes, high blood pressure, and high cholesterol can prevent strokes, heart attacks and poor circulation in extremities. We also recommend that women who have migraine with aura should not take estrogen-based oral contraceptives or hormone replacement therapy since estrogen in these women also increases the risk of strokes. All migraine suffererss (and everyone else) should not smoke and exercise regularly, which also reduces the risk of the conditions mentioned above.
Read MoreMedications used for the preventive treatment of migraine headaches can cause weight loss, but more often cause weight gain. An interesting study by Dr. Bigal and his colleagues, just published in Cephalalgia looked at this effect of drugs in 331 patients. They found that 16% of them gained weight (5% or more of their baseline weight) and 17% lost weight. The various treatments given to these patients were equally effective in both groups. However, not surprisingly, those who gained weight had elevation of their cholesterol, blood glucose, blood pressure and pulse. Patients who have migraine headaches with aura (about 15-20% of migraine sufferers) already have an increased risk of strokes, so adding additional risk factors for both strokes and heart attacks should be especially avoided in this group. The only preventive migraine drug which consistently lowers weight in many patients is topiramate (Topamax). This drug is now available in a generic form, making it much less expensive. While topiramate does lower weight and helps prevent migraine headaches only half of the patients stay on it. For the other half it causes unpleasant side effects (memory impairment and other) or it does not work.
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