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Migraine and Heart Rate Variability

Migraine and Heart Rate Variability We read with interest the article by Kurth et al1 on the association between migraine and increased risk of CVD in men. In a previous study, the authors have reported an association among active migraine with aura and increased risk of CVD, CHD, and ischemic stroke in women.2 The biological link between migraine and CVD and CHD is complex and currently unclear. Several mechanisms may be involved such as prothrombotic and vasoactive factors. We report preliminary data from our study showing the presence of cardiac autonomic dysfunction in subjects with migraine. A total of 28 subjects (18 women and 10 men; mean ± SD age, 36 ± 4.2 years) with active migraine with aura, diagnosed according to criteria of the International Headache Society, were enrolled. All subjects were normotensive and normal weight and without metabolic, endocrine, cardiovascular, and renal diseases, and they were not receiving drugs that could potentially disturb cardiac autonomic activity. Twenty-five healthy subjects matched for sex, age, body mass index, and blood pressure were enrolled as a control group. In all subjects, a 24-hour electrocardiographic recording was performed, and heart rate variability was analyzed in time and frequency domain according to European Society of Cardiology guidelines.3 Spectral estimated R-R intervals were obtained from stationary regions free of ectopic beats and technical artifacts. In a time domain analysis, the standard deviation of normal R-R intervals (SDNN), correlated with total autonomic activity, was calculated. In a frequency domain analysis, low frequency–high frequency ratio, considered as an index of sympathovagal balance, was calculated. During electrocardiographic recording, all subjects had not reported migraine attacks. Findings from the time domain analysis of heart rate variability has shown a lower SDNN mean ± SD value in subjects with migraines than in control subjects (98.21 ± 20.71 vs 173.19 ± 16.03; P < .001). In frequency domain analysis, the low frequency–high frequency ratio was reported to be increased in subjects with migraine vs control subjects (mean ± SD, 2.35 ± 0.11 vs 1.72 ± 0.18; P = .006). The data show that subjects with active migraine with aura have a lower heart rate variability characterized by sympathetic hyperactivity. Results from population-based follow-up studies, such as the Zutphen Study4 and the Framingham Heart Study,5 have shown that lower heart rate variability is associated with the risk of developing CVD. We conclude that migraine is associated with impaired heart rate variability and propose that this is an additional mechanism involved in the relationship between migraine and major risk of CVD. Further prospective studies are needed to confirm this hypothesis. Correspondence: Dr Perciaccante, Department of Clinical Medicine, University “La Sapienza,” Viale dell’Università, 38 00185 Rome, Italy (antonioperciaccante@libero.it). References 1. Kurth TGaziano JMCook NR et al. Migraine and risk of cardiovascular disease in men. Arch Intern Med 2007;167 (8) 795- 801PubMedGoogle ScholarCrossref 2. Kurth TGaziano JMCook NRLogroscino GDiener HCBuring JE Migraine and risk of cardiovascular disease in women. JAMA 2006;296 (3) 283- 291PubMedGoogle ScholarCrossref 3. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;93 (5) 1043- 1065PubMedGoogle ScholarCrossref 4. Dekker JMSchouten EGKlootwijk PPool JSwenne CAKromhout D Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men: the Zutphen Study. Am J Epidemiol 1997;145 (10) 899- 908PubMedGoogle ScholarCrossref 5. Tsuji HLarson MGVenditti FJ Jr et al. Impact of reduced heart rate variability on risk for cardiac events: the Framingham Heart Study. Circulation 1996;94 (11) 2850- 2855PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0003-9926
DOI
10.1001/archinte.167.20.2264-a
pmid
17998506
Publisher site
See Article on Publisher Site

Abstract

We read with interest the article by Kurth et al1 on the association between migraine and increased risk of CVD in men. In a previous study, the authors have reported an association among active migraine with aura and increased risk of CVD, CHD, and ischemic stroke in women.2 The biological link between migraine and CVD and CHD is complex and currently unclear. Several mechanisms may be involved such as prothrombotic and vasoactive factors. We report preliminary data from our study showing the presence of cardiac autonomic dysfunction in subjects with migraine. A total of 28 subjects (18 women and 10 men; mean ± SD age, 36 ± 4.2 years) with active migraine with aura, diagnosed according to criteria of the International Headache Society, were enrolled. All subjects were normotensive and normal weight and without metabolic, endocrine, cardiovascular, and renal diseases, and they were not receiving drugs that could potentially disturb cardiac autonomic activity. Twenty-five healthy subjects matched for sex, age, body mass index, and blood pressure were enrolled as a control group. In all subjects, a 24-hour electrocardiographic recording was performed, and heart rate variability was analyzed in time and frequency domain according to European Society of Cardiology guidelines.3 Spectral estimated R-R intervals were obtained from stationary regions free of ectopic beats and technical artifacts. In a time domain analysis, the standard deviation of normal R-R intervals (SDNN), correlated with total autonomic activity, was calculated. In a frequency domain analysis, low frequency–high frequency ratio, considered as an index of sympathovagal balance, was calculated. During electrocardiographic recording, all subjects had not reported migraine attacks. Findings from the time domain analysis of heart rate variability has shown a lower SDNN mean ± SD value in subjects with migraines than in control subjects (98.21 ± 20.71 vs 173.19 ± 16.03; P < .001). In frequency domain analysis, the low frequency–high frequency ratio was reported to be increased in subjects with migraine vs control subjects (mean ± SD, 2.35 ± 0.11 vs 1.72 ± 0.18; P = .006). The data show that subjects with active migraine with aura have a lower heart rate variability characterized by sympathetic hyperactivity. Results from population-based follow-up studies, such as the Zutphen Study4 and the Framingham Heart Study,5 have shown that lower heart rate variability is associated with the risk of developing CVD. We conclude that migraine is associated with impaired heart rate variability and propose that this is an additional mechanism involved in the relationship between migraine and major risk of CVD. Further prospective studies are needed to confirm this hypothesis. Correspondence: Dr Perciaccante, Department of Clinical Medicine, University “La Sapienza,” Viale dell’Università, 38 00185 Rome, Italy (antonioperciaccante@libero.it). References 1. Kurth TGaziano JMCook NR et al. Migraine and risk of cardiovascular disease in men. Arch Intern Med 2007;167 (8) 795- 801PubMedGoogle ScholarCrossref 2. Kurth TGaziano JMCook NRLogroscino GDiener HCBuring JE Migraine and risk of cardiovascular disease in women. JAMA 2006;296 (3) 283- 291PubMedGoogle ScholarCrossref 3. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;93 (5) 1043- 1065PubMedGoogle ScholarCrossref 4. Dekker JMSchouten EGKlootwijk PPool JSwenne CAKromhout D Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men: the Zutphen Study. Am J Epidemiol 1997;145 (10) 899- 908PubMedGoogle ScholarCrossref 5. Tsuji HLarson MGVenditti FJ Jr et al. Impact of reduced heart rate variability on risk for cardiac events: the Framingham Heart Study. Circulation 1996;94 (11) 2850- 2855PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 12, 2007

References