Background Migraine carries a high global burden, disproportionately affects women, and has been implicated as a risk factor for cardiovascular disease. Migraine with aura has been consistently associated with increased risk of cardiovascular mortality. However, published evidence on relationships between migraine or non-migraine headache and all-cause mortality is inconclusive. Therefore, we aimed to estimate the effect of non-migraine headache and migraine as well as migraine subtypes on all-cause and cause-specific mortality in women. Methods In total, 27,844 Women’s Health Study participants, aged 45 years or older at baseline, were followed up for a median of 22.7 years. We included participants who provided information on migraine (past history, migraine without aura, or migraine with aura) or headache status and a blood sample at study start. An endpoints committee of physicians evaluated reports of incident deaths and used medical records to confirm deaths due to cardiovascular, cancer, or female-specific cancer causes. We used multivariable Cox proportional hazards models to estimate the effect of migraine or headache status on both all-cause and cause-specific mortality. Results Compared to individuals without any headache, no differences in all-cause mortality for individuals suffering from non-migraine headache or any migraine were observed after adjustment for confounding (HR = 1.01, 95%CI, 0.93–1.10 and HR = 0.96, 95% CI: 0.89–1.04). No differences were observed for the migraine subtypes and all-cause death. Women having the migraine with aura subtype had a higher mortality due to cardiovascular disease (adjusted HR = 1.64, 95%CI: 1.06–2.54). As an explanation for the lack of overall association with all-cause mortality, we observed slightly protective signals for any cancer and female-specific cancers in this group. Conclusions In this large prospective study of women, we found no association between non-migraine headache or migraine and all-cause mortality. Women suffering from migraine with aura had an increased risk of cardiovascular death. Future studies should investigate the reasons for the increased risk of cardiovascular mortality and evaluate whether changes in migraine patterns across the life course have differential effects on mortality.

中文翻译：

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女性偏头痛、头痛和死亡率：一项队列研究


背景 偏头痛给全球带来了沉重的负担，对女性的影响尤为严重，并且被认为是心血管疾病的危险因素。有先兆偏头痛一直与心血管死亡风险增加相关。然而，已发表的关于偏头痛或非偏头痛与全因死亡率之间关系的证据尚无定论。因此，我们的目的是评估非偏头痛和偏头痛以及偏头痛亚型对女性全因和特定原因死亡率的影响。方法 总共有 27,844 名女性健康研究参与者，基线年龄为 45 岁或以上，随访时间中位数为 22.7 年。我们纳入了在研究开始时提供偏头痛（既往病史、无先兆偏头痛或有先兆偏头痛）或头痛状态信息以及血液样本信息的参与者。由医生组成的终点委员会评估了事件死亡报告，并使用医疗记录来确认因心血管、癌症或女性特有癌症原因造成的死亡。我们使用多变量 Cox 比例风险模型来估计偏头痛或头痛状态对全因死亡率和特定原因死亡率的影响。结果 与没有任何头痛的个体相比，在调整混杂因素后，非偏头痛或任何偏头痛个体的全因死亡率没有差异（HR = 1.01, 95% CI, 0.93–1.10 和 HR = 0.96, 95） % CI：0.89–1.04）。偏头痛亚型和全因死亡没有观察到差异。患有先兆偏头痛亚型的女性因心血管疾病死亡率较高（调整后 HR = 1.64，95% CI：1.06–2.54）。 作为与全因死亡率缺乏总体关联的解释，我们观察到该组中任何癌症和女性特有癌症的轻微保护信号。结论 在这项针对女性的大型前瞻性研究中，我们发现非偏头痛或偏头痛与全因死亡率之间没有关联。患有先兆偏头痛的女性心血管死亡的风险增加。未来的研究应该调查心血管死亡风险增加的原因，并评估整个生命过程中偏头痛模式的变化是否对死亡率有不同的影响。