Does migraine with visual aura indicate risk of atrial fibrillation?

In this paper, researchers assessed the association between migraines with visual aura and atrial fibrillation (AF).

Study design

This study included 11,939 participants from the longitudinal, community-based Atherosclerosis Risk in Communities study. They were interviewed for migraine history between 1993 and 1995 and followed for incident AF through 2013. All particpants were assessed for headache and did not have prior AF or stroke.

Outcomes

During the 20-year follow-up, atrial fibrillation was noted in 15% of the 1,516 patients reporting migraine and 17% of the 9,405 patients without migraine (P=0.0002). Among patients with migraine, atrial fibrillation occurred more frequently in patients with visual aura than in those without visual aura (18% vs. 14%; P=0.008). Analysis adjusted for confounders revealed only migraine with aura associated with increased risk of AF (HR 1.30). The majority of the cardioembolic stroke cases (87%) could be attributed to AF.

Limitations

The study did not assess which subjects had a patent foramen ovale, a known risk factor for embolism that can be associated with AF. The study also relied upon hospital discharge codes and death certificates to identify subjects with AF.

Clinical significance

It is known that some patients with migraine can be at a higher risk for stroke. This study raises questions regarding whether atrial fibrillation might be a causative risk factor for stroke in patients with migraine with visual aura. Further study of this potential association is necessary before concluding that patients with migraine with visual aura require a cardiac work-up.