Migraine with visual aura tied to Afib risk

  • Sen S & al.
  • Neurology
  • 14 Nov 2018

  • curated by Susan London
  • Clinical Essentials
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  • Individuals reporting migraine with visual aura had a 30% higher risk of developing Afib than counterparts who did not experience any headaches.

Why this matters

  • Migraine is associated with elevated stroke risk, although specific mechanisms are still being elucidated.

Key results

  • Cohort distribution:
    • 3.6% migraine with visual aura;
    • 9.1% migraine without visual aura;
    • 8.5% nonmigraine headache;
    • 78.8% no headache.
  • Over 20 years, incident Afib occurred in 15% of individuals with migraine and 17% of individuals without headache.
  • In adjusted analysis, migraine with visual aura carried elevated Afib risk:
    • Compared with no headache (HR, 1.30; P=.02);
    • Compared with migraine without visual aura (HR, 1.39; P=.0084).
  • Migraine without aura was not associated with elevated Afib risk compared with no headache.

Expert comment

  • In an editorial, Dr. Sebastian Fridman and Dr. Luciano A. Sposato write, “More research is needed to confirm their [the] results and to better understand how MVA, atrial fibrillation, and ischemic stroke interact with each other… a randomized trial of prolonged cardiac monitoring in selected patients with MVA may shed light on this matter.”

Study design

  • Longitudinal, community-based cohort study of 11,939 participants initially aged 45-64 in the Atherosclerosis Risk in Communities study who did not have Afib and had not experienced stroke.
  • Main outcome: incident Afib.
  • Funding: National Heart, Lung, and Blood Institute; American Heart Association.


  • Potential unmeasured confounders (e.g., patent foramen ovale, migraine medications).
  • Some cases of migraine and of paroxysmal Afib may have been missed.

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