Migraine effect on cardiovascular health controversial

Shelby Ramsey

Special to the Village News

In researching the effect migraine and other chronic health conditions (non-heart related) may have on one's cardiovascular health, top-rated U.S. cardiologist Dr. Steven Nissen offered his opinion.

Nissen was very forthcoming and said that the topic is a controversial area. He explained that there have been some observational studies done that included two patient groups (migraine with aura and migraine without aura). The term aura is used for the visual disturbances some experience with migraine headache.

The results were that "specifically migraine [patients] with aura are more likely to develop coronary heart disease," Nissen said. It is important to note that an observational study is solely considered an association, not definitive evidence.

"There's a big difference between association and causation," he said. "And so we can say there may be an association between migraine and cardiovascular disease, but the proof has simply not been established and so it is considered something which is still on the speculative side."

With good reason, cardiovascular health is frequently shared amongst friends, family and colleagues in conversation. In some way or another, most families have had an experience with a cardiovascular condition.

Those who live with a chronic health condition that is not cardiac-related (such as migraine) may have wondered if there was a way to isolate and thereby protect their cardiovascular health.

"You really cannot isolate the cardiovascular system from everything else," Nissen said. "The body is an amazing system, everything is interconnected."

It was a viable question, though. "It's quite true that there are a variety of disorders that you would think that are not related to each other that turn out to be related," he said. He cited examples such as diabetes and heart disease, cholesterol and blood pressure.

Since separating cardiovascular health and a chronic health condition is not possible, Nissen's advice for patients and individuals alike is "to practice good health habits and in general, if you do, things will work out."

As adults, we have been exposed to many educational messages about maintaining healthy heart practices, watching our diets, and maintaining a healthy weight.

We have heard that cholesterol levels have a strong link to cardiac health. When getting a physical or other blood work, our cholesterol levels are generally checked and reported back to us by our doctor. But how early should a person's cholesterol start to be monitored?

Nissen said, "There's been a lot of movement in this area toward testing most children probably in early adolescence, but some pediatricians test even earlier."

This is definitely more proactive than years ago. Nissen said in previous generations, "we didn't used to check it until people [were] in their 30s."

Nissen advised that blood work can reveal genetic disorders too, "which you want to find relatively early in life."

When it comes to cholesterol levels, "It's the total area under the curve for cholesterol for your lifetime that determines your risk," Nissen said.

There are plenty of reasons to be more proactive about our overall health. Having our cholesterol levels checked (and reminding family members who are unaware) is vital. It's also a good idea to follow a healthy eating program, and/or start treatment options if cholesterol readings are at an undesirable level.

In general, Nissen recommended that parents have a child's cholesterol checked at age 13. The results from that initial test can dictate if any proactive steps need to be taken.

Widely-known as a respected patient advocate, Nissen offered some sage advice.

"It's never wrong to ask for a second opinion," he said. That can include just not being sure about a doctor, a response given, an invasive procedure with risk factors, or if you feel best getting a second opinion before moving forward.

An individual's medical team and the experts they choose to oversee their treatment plays a heavy role in their overall health, accessibility and treatment options.

Nissen was quite adamant when he said, "Good doctors never resent you asking for a second opinion. Bad doctors do. So don't be afraid to ask for a second opinion."

Dr. Steven Nissen is Chief Academic Officer of the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic. He formerly served as President of the American College of Cardiology.

Shelby Ramsey is the author of the blog, thehonestmigraine.com, which also features interviews with patients and medical experts.