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ARTICLES: Tobias Kurth, Markus Schürks, Giancarlo Logroscino, and Julie E. Buring Migraine frequency and risk of cardiovascular disease in women Neurology 2009; 0: WNL.0b013e3181ab2c20v1 [Abstract]

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Migraine frequency and risk of cardiovascular disease in women

James M. Gordon   (2 September 2009)

Reply from the authors

Tobias Kurth, and Markus Schürks   (2 September 2009)

Migraine frequency and risk of cardiovascular disease in women 2 September 2009
James M. Gordon, Northwest Hospital and Medical Center 1570 N 115th St., Suite 14, Seattle, WA 98133 Send Correspondence to journal: Re: Migraine frequency and risk of cardiovascular disease in women neurojim{at}yahoo.com James M. Gordon	Kurth et al. provide interesting information on migraine frequency and risk of cardiovascular disease in women. However, their data are difficult to interpret because self-reporting probably underestimates the "N" of migraine without aura. [1] The authors state that persons reporting having migraine usually meet IHS criteria, which diminishes the risk of over-reporting. In community practice, we recognize that the world is full of migraineurs and migraineuses who remain undiagnosed—sometimes for decades—until a neurologist sees them for refractory sinus or neck pain. Although migraine with aura is less likely to remain undiagnosed, self-reporting seems to make under-reporting of common migraine inevitable. In the present study, it is unclear whether expanding the denominator would have driven the risk up or down. A future study may resolve this issue and should include questioning subjects about headache frequency and characteristics rather than the presence or absence of "migraine." Reference 1. Kurth T, Schurks M, Logroscino G, Buring J. Migraine frequency and risk of cardiovascular disease in women. Neurology 2009;73:581-588. Disclosure: Dr. Gordon reviewed charts for The Doctors Company, a medical malpractice insurer.
Reply from the authors 2 September 2009
Tobias Kurth, INSERM Unit 708-Neuroepidemiology Hôpital de la Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75651 Paris Cedex 13, France, and Markus Schürks Send Correspondence to journal: Re: Reply from the authors tkurth{at}rics.bwh.harvard.edu Tobias Kurth, et al.	Ascertainment of specific headache forms in large scale, population-based studies as well as in clinic-based settings is challenging and some degree of misclassification is possible. Dr. Gordon points out that potential under-reporting of migraine without aura may have influenced our findings relating to the association between migraine frequency and risk of cardiovascular disease. [1] While patients with migraine without aura may not report their condition adequately, we are confident that such patients would at least report having a headache. Since neither migraine without aura or non-migraine headache is associated with increased risk of ischemic stroke [2] or other ischemic vascular events in the Women’s Health Study [3], we believe that such potential misclassification is an unlikely explanation of our findings. References 2. Kurth T, Slomke MA, Kase CS, et al. Migraine, headache, and the risk of stroke in women: a prospective study. Neurology 2005;64:1020-1026. 3. Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener HC, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA 2006;296:283-291. Disclosure: Dr. Kurth received funding for travel from the Restless Legs Syndrome Foundation; received honoraria for educational lectures from Genzyme, Pfizer, and Merck; serves as a consultant to i3 Drug Safety and World Health Information Science Consultants LLC; and receives research support from Merck (IISP ID 35437), NIH (HL091880 [PI]; NS061836 [PI]). Dr. Schuerks received an honorarium from L.E.K. Consulting; received research support from the German Research Foundation (Deutsche Forschungsgemeinschaft [DFG]).