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Migraine and Stroke, Heart Disease: Understanding the Risks

Learning that research has found connections between migraine and stroke and heart disease can be chilling. Fortunately, the news is not as bad as it might first appear. I spoke with headache specialist Gretchen Tietjen, M.D., about an article on the connection between migraine and an increased risk of stroke and cardiovascular disease that she wrote for the American Migraine Foundation. “From a patient’s perspective, this information is frightening,” I told her (because I have no poker face, even on the telephone). Dr. Tietjen soothed my worries tremendously by putting the information into perspective.

“It can be very scary when you read things like this,” Dr. Tietjen said. “Study after study shows this little bit of increase.” However, the risk is very small. The most important takeaway is that patients should keep migraine in mind as part of their overall risk for stroke and heart disease. If you have migraine and are at increased risk of stroke or heart disease, it’s extra important to be aware of and manage those risk factors.

Migraine Increases the Risk of Stroke and Cardiovascular Diesease (But Only a Little Bit)

Yes, migraine does increase the risk of stroke, particularly for women who have migraine with aura. But the risk is very, very small. Less than 1% of all strokes in women have any connection to migraine. And the presence of a connection is not proof of a causal relationship—that is, just because the two are linked doesn’t mean that migraine causes stroke.

The article reports that a recent study found “that migraine increases the risk of stroke, coronary events, and related death by about 50%.” At first glance, that sounds terrifying, but Dr. Tietjen’s clarification was soothing. She said, “This sounds worrisome but to put this in perspective only 1% of the total population in the study had a cardiovascular event over the 20 years of follow-up. The take home message is that having migraine does not mean you will have heart disease or a stroke, only that it appears to slightly increase the risk.”

Risk Factors For Stroke and Heart Disease

Dr. Tietjen highlighted risk factors like smoking, high blood pressure, high cholesterol, and diabetes. She said that in people with migraine, these factors have an additive effect—the combination of more than one risk factor is worse than any one by itself. If you have any of these risk factors in addition to migraine, quitting smoking, lowering your blood pressure and/or cholesterol, or getting your diabetes under control could lower your risk of heart disease substantially. Smoking is the risk factor that stands out the most to Dr. Tietjen. Studies of migraine and smoking have shown that the combination of the two increases your stroke and heart disease risk more than either one on it’s own.

Learn More About Migraine, Stroke and Heart Disease

Dr. Tietjen’s article, Migraine, Stroke and Heart Disease has in-depth information on who is at increased risk of stroke, differentiating between symptoms of migraine and stroke, the physiological links between migraine and stroke, and ways to lower your risk. As you read the article, keep in mind that the absolute risk is small and that you can modify your risk factors for stroke and heart disease. And make a list of any questions you may have so you can ask your doctor at your next appointment.

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Headache and Migraine Patient Conference June 29!

The second annual headache and migraine patient conference will be June 29, 2014 in Los Angeles. Last year’s conference was really informative and, while my migraine was too severe for me to be social, I still learned a ton.

Multiple sessions will be held concurrently, so you can choose what topics you want to learn about, including managing cluster headache, brain changes during migraine, sex differences in migraine treatment, and complementary and alternative therapies. There will also be a session for loved ones to talk about the challenges they face as caregivers. Some top headache specialists will be presenting, including Dr. Andrew Charles (UCLA), Dr. Rob Cowan (Stanford) and Dr. Peter Goadsby (UCSF).

Get details and register. Scholarships of up to $500 will be offered for travel expenses. The scholarship application deadline is Friday, May 30. Help for Headaches has scholarship details.

I’m still not sure if I’ll make it this year, but leave a comment if you’re going and we can be sure to meet up if I do!

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Testing if Your DAO Level is Low

Yes, there’s a test that measures diamine oxidase (DAO) levels in the blood. No, it’s probably not worth your time or money to get it done. (Wondering what DAO is? Start reading here and follow the links at the bottom of that post for more information.)

There are two issues. The first is there’s no well-established range of DAO levels. There’s speculation and you’ll find ranges listed, but they aren’t yet backed by solid science. Also, it’s not known whether the amount of DAO in your blood is indicative of how much is in your gut, which is where it really matters.

Genetic testing can show if you have mutations in the genes related to DAO production, but not how much you actually produce. While the test confirmed that I probably make insufficient amounts of DAO, dietary research, an elimination diet and testing DAO supplements were more informative.

The best way to find out if you’re low in DAO is to try taking the supplement. You can get small a bottle of the highest strength DAO for about $30. If you’re going for a high dose, use Histamine Block rather than Histame. (The Amazon link defaults to the more expensive 60 capsule bottle. Click on “30 Easy-To-Swallow Vegetarian Capsules” in the box below the “in stock” notice to choose the less expensive bottle).

It took about a month of playing with the amount of DAO I took and how long before meals to take it before I hit on the right set up for me. The label recommends taking two no more than 15 minutes before every meal. I’ve found each capsule covers about 400 calories, though I take more if I’m eating a high-histamine food, like fish. I currently take it about 8 minutes before eating (or even drinking coffee or herbal tea) and am sure to finish eating within 45 minutes. As you’ve read, the change was drastic once I hit on the right combination.

This was while eating a low-histamine diet, which I recommend trying. Even if you don’t, read the list of high-histamine foods and take extra DAO when you eat them. (Some of those foods are also high in tyramine, which has long thought to be a migraine trigger. DAO does not help process tyramine and there is no digestive enzyme that claims to.)

The capsules are expensive (about $1 each), so I initially felt a lot of pressure to take no more than I absolutely needed. For the sake of dietary variety, I’ve relaxed a bit and now err on the side of too much with foods I’m uncertain about. Other than pocketbook pain, I have no noticeable side effects. I thought heartburn was an issue for a while, but that has resolved (it was likely due to reintroducing fat after going so many months on a very low fat diet). I’ve been reassured that DAO is safe and that any that’s unused gets flushed right out. That’s why you have to take it before every time you eat — it doesn’t stick around.

I know many of you are hoping that DAO will help you as much as it has me. If you do decide to try it, play around with dosing and when you take it. If you get any relief from it, it might be another addition to your treatment plan. Every little bit adds up.

Still have questions? Please ask them in the comments or email me at kerrie[at]thedailyheadache[dot]com and I’ll try to answer them.

Related posts:

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Which is correct, “migraine” or “migraines”?

Ever wonder why migraine sometimes has an S on the end sometimes and sometimes doesn’t? Migraine or Migraines?, my latest Migraine.com post, explains why this is and when each one is correct. Here’s an excerpt:

Which word is correct, migraine or migraines? The answer is both, though the two words have different meanings. Migraine without an S means the underlying neurological disorder. With an S on the end, migraines refer to the individual attacks that a person who has migraine experiences. A parallel without the confusing verbiage is epilepsy and seizures — a person who has epilepsy has seizures, a person who has migraine has migraines.

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Book Your AHMA Conference Hotel Room Today; Rates Increase Sunday

Planning on attending the American Headache & Migraine Association patient conference in Scottsdale, AZ on Nov. 24 and haven’t booked your hotel room yet? The Hampton Inn’s special rate of $85 (plus tax) per night is only available through tomorrow, Saturday, Nov. 2. Rooms include two double beds, a refrigerator and microwave, plus complimentary breakfast, a free shuttle within a three-mile radius, and transportation to and from the conference on Sunday.

This is a great rate for a nice hotel in a convenient part of town — tons of great restaurants and shopping are nearby, and there are even a few grocery stores within walking distance. Be sure to book today (or tomorrow) to secure this rate.

Looking to share a room with other conference attendees? Check the members-only AHMA forum to find roommates. Members are also planning outings while in Arizona, like a trip to the Grand Canyon — check the forum to join up.