- First, clinicians should assess cardiac history as well as CV risk factors in patients with migraine, and obtain a thorough CV history before prescribing vasoconstrictors.
- Patients who were free of CVD when initially prescribed these medications should receive periodic CV risk assessments over time.
- Finally, non-vasoconstrictive treatments may play an important role in the acute treatment of migraine, especially in women ≥ 60 years and men ≥ 40 years.
THE TAKE HOME POINTS
• About 900,000 Americans with episodic migraine are at high CV risk and/or have had a past CV event or procedure, making the prescription of ergots or triptans potentially problematic for these patients
• Over 360,000 women and men aged 60+ who have episodic migraine may be at risk for a first CV event in the next 10 years
• Clinicians should assess CV history and CV risk factors before prescribing ergots or triptans, and periodically assess CV risk factors in patients on these medications over time
• Women are at higher risk for episodic migraine than men, and clinicians should remain vigilant to CV disease in women
1. Lipton RB, Reed ML, Kurth T, et al. Framingham-based cardiovascular risk estimates among people with episodic migraine in the US population: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2017 Oct 9.
2. Buse DC, Reed ML, Fanning KM, et al. Cardiovascular events, conditions, and procedures among people with episodic migraine in the US population: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2017;57:31-44.