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Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study

BMJ 2010; 341 doi: (Published 24 August 2010) Cite this as: BMJ 2010;341:c3966
  1. Larus S Gudmundsson, doctoral student1,
  2. Ann I Scher, associate professor2,
  3. Thor Aspelund, associate professor34,
  4. Jon H Eliasson, neurologist5,
  5. Magnus Johannsson, professor1,
  6. Gudmundur Thorgeirsson, professor46,
  7. Lenore Launer, senior investigator7,
  8. Vilmundur Gudnason, professor34
  1. 1Department of Pharmacology and Toxicology, University of Iceland, Hagi Hofsvallagata 53, IS-107 Reykjavik, Iceland
  2. 2Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD, USA
  3. 3Icelandic Heart Association, Holtasmara 1, IS-201 Kopavogur, Iceland
  4. 4University of Iceland, Reykjavik, Iceland
  5. 5Reykjalundur Rehabilitation Centre, Mosfellsbær, Iceland
  6. 6Landspitali University Hospital, Reykjavik, Iceland
  7. 7Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA
  1. Correspondence to: L S Gudmundsson lsg{at}, V Gudnason v.gudnason{at}
  • Accepted 12 July 2010


Objective To estimate whether migraine in mid-life is associated with mortality from cardiovascular disease, other causes, and all causes.

Design Population based cohort study.

Setting Reykjavik, Iceland.

Participants 18 725 men and women, born 1907-35 and living in Reykjavik and adjacent communities.

Main outcome measures Mortality from cardiovascular disease, non-cardiovascular disease, and all causes. Questionnaires and clinical measures were obtained in mid-life (mean age 53, range 33-81) in the Reykjavik Study (1967-91). Headache was classified as migraine without aura, migraine with aura, or non-migraine headache. Median follow-up was 25.9 years (0.1-40.2 years), with 470 990 person years and 10 358 deaths: 4323 from cardiovascular disease and 6035 from other causes. We used Cox regression to estimate risk of death in those with migraine compared with others, after adjusting for baseline risk factors.

Results People with migraine with aura were at increased risk of all cause mortality (adjusted (for sex and multivariables) hazard ratio 1.21, 95% confidence interval 1.12 to 1.30) and mortality from cardiovascular disease (1.27, 1.13 to 1.43) compared with people with no headache, while those with migraine without aura and non-migraine headache were not. Further examination of mortality from cardiovascular disease shows that people with migraine with aura were at increased risk of mortality from coronary heart disease (1.28, 1.11 to 1.49) and stroke (1.40, 1.10 to 1.78). Women with migraine with aura were also at increased risk of mortality from non-cardiovascular disease (1.19, 1.06 to 1.35).

Conclusions Migraine with aura is an independent risk factor for cardiovascular and all cause mortality in men and women. The risk of mortality from coronary heart disease and stroke mortality is modestly increased in people with migraine, particularly those with aura.


  • We thank all the employees of the Icelandic Heart Preventive Clinic (Hjartavernd) for their skilful contribution to the data collection.

  • Contributors: LSG, AIS, LL, and VG designed the study. LSG and TA analysed the data. LSG and VG drafted the paper. TA and VG acquired the data. LSG and TA take responsibility for the integrity of the data and the accuracy of the data analysis. All authors had access to the data, interpreted the data, critically revised the draft for important intellectual content, and gave final approval of the manuscript to be published. LSG and VG are guarantors.

  • Funding: This study was funded by the University of Iceland Research Fund. The current study was conducted without any influence from the University of Iceland Research Fund.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that no company has supported the submitted work; LSG has received a travel grant from the Pharmaceutical Society of Iceland Science Fund, AIS has served on advisory boards for Endo Pharmaceuticals and OrthoMcNeil Neurologics, has received an honorarium and a travel grant from the National Headache Foundation and a travel grant from the American Headache Society; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Surgeon General’s ethics committee 1969, and informed consent was given by all participants.

  • Data sharing: No additional data are available.

  • Accepted 12 July 2010

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