Cardiovascular diseases are the leading cause of death worldwide, according to the WHO. Their risk factors are well known and many can be changed. This article reviews them, explains why migraine with aura is worth mentioning to your doctor, and lists the signs that call for emergency help.
What are the main cardiovascular risk factors?
According to the WHO, heart attacks and strokes account for more than four out of five cardiovascular deaths, and one third of these deaths occur before the age of 70. The WHO describes several groups of factors:
- behavioural: an unbalanced diet, physical inactivity, tobacco use and the harmful use of alcohol;
- measurable in primary care: high blood pressure, high blood sugar, high blood lipids, and overweight or obesity;
- underlying: ageing, income, urbanisation and air pollution.
These factors add up. They often cause no symptoms: a heart attack or a stroke can be the first sign of a disease of the blood vessels.
Blood pressure, cholesterol, blood sugar: numbers to know
High blood pressure, high cholesterol and diabetes are among the factors that promote damage to the coronary arteries, as the Mayo Clinic points out. Because they are silent, only a measurement can detect them: a blood pressure check and a blood test for cholesterol and blood sugar.
According to the same source, a medical evaluation can determine your personal risk, and a doctor may prescribe a cholesterol-lowering treatment if deposits in the arteries are found. Target values depend on the individual: discuss them with your doctor.
Weight, physical activity and diet
Overweight, inactivity and an unbalanced diet are modifiable risk factors. For adults aged 18 to 64, the WHO recommends at least 150 minutes of moderate-intensity activity per week, or at least 75 minutes of vigorous activity, and notes that physical activity lowers the risk of coronary heart disease, stroke, high blood pressure and diabetes.
The Mayo Clinic advises eating plenty of fruit, vegetables and whole grains, and limiting salt, animal fats and processed foods. If you would like to check your weight, you can calculate your body mass index (BMI) below, then talk to your doctor about it.
Smoking, alcohol, age and family history
Smoking clearly raises the risk: according to the Mayo Clinic, smoking or using other tobacco products substantially increases the risk of heart disease, and quitting should be considered as soon as possible. A parent who had a heart attack, especially before the age of 55, is also an important risk factor.
The WHO also lists the harmful use of alcohol and ageing. These last two points, like heredity, cannot be changed, or only slightly: they mainly call for closer attention to the factors you can act on.
Migraine with aura: why tell your doctor?
Aura refers to temporary, reversible neurological symptoms, often visual (blind spots, flickering lights), sometimes tingling or speech difficulties. It most often lasts 5 to 60 minutes, and up to one third of people with migraine experience it, according to the Migraine Trust.
According to the American Heart Association, doctors accept that, in women, migraine with aura is associated with a doubling of stroke risk, and it is also linked to a higher risk of heart attack. The experts quoted stress, however, that the individual risk remains low: the American Migraine Foundation estimates that 2,000 to 3,000 of the roughly 800,000 strokes each year in the United States are related to migraine. Their advice is simple: tell your doctors that you have migraine with aura, and reduce your other risk factors (smoking, blood pressure, blood sugar, cholesterol, weight). Women who take oral contraception should discuss it with their doctor and should not smoke.
What triggers migraine?
According to the Health Service Executive (HSE) in Ireland, triggers do not cause an attack but make one more likely. They include:
- hormonal changes, especially around periods;
- stress, anxiety, tension or excitement;
- sleep problems, shift work and jet lag;
- skipped or irregular meals, dehydration, alcohol, caffeine and certain foods;
- bright or flickering lights, loud noises and strong smells;
- certain medicines, including oestrogen-containing contraceptives or treatments.
Identifying your own triggers, for example by keeping a diary of your attacks, helps you talk to your doctor more precisely.
When to see a doctor, when to call emergency services
See your doctor to have your blood pressure, cholesterol and blood sugar checked, especially if you have a family history, smoke or have migraine with aura. Also report headaches that are more frequent than usual or that suddenly become intense: the AHA states that they should be evaluated to rule out a stroke.
According to the WHO, call emergency services immediately for:
- pain or discomfort in the centre of the chest, or pain in the arms, left shoulder, jaw or back, with shortness of breath, nausea, cold sweats or feeling faint;
- sudden weakness or numbness of the face, arm or leg, often on one side only;
- confusion, difficulty speaking or understanding, vision problems, difficulty walking, or a severe headache with no known cause.
Women more often than men have shortness of breath, nausea, vomiting and back or jaw pain.
Further reading at La Rose Clinic
Frequently asked questions
Does migraine increase the risk of stroke?
According to the AHA, migraine with aura is associated with a doubling of stroke risk in women, but the individual risk remains low. Tell your doctor about it.
Which risk factors can I change?
Smoking, inactivity, diet, weight, alcohol, and monitoring of blood pressure, cholesterol and blood sugar. Age and heredity cannot be changed.
Can you have cardiovascular disease without symptoms?
Yes. The WHO stresses that there are often no symptoms and that a heart attack or stroke can be the first sign.
Is a sudden, violent headache an emergency?
A severe headache with no known cause, especially with weakness or speech or vision problems, means you should call emergency services without delay.
References
- Cardiovascular diseases (WHO) (who.int)
- Regardless of risk, take steps to protect heart health (Mayo Clinic) (newsnetwork.mayoclinic.org)
- What migraine sufferers need to know about stroke risk (AHA) (heart.org)
- Migraine: causes and triggers (HSE) (hse.ie)
- Stages of a migraine attack (Migraine Trust) (migrainetrust.org)
- Physical activity (WHO) (who.int)
This article is for information only. It does not replace a medical consultation: if in doubt, talk to your doctor.
