Migraine and Atrial Fibrillation: a Systematic Review

BACKGROUND Patients with migraine are at increased risk of stroke. We aim to systematically review the current literature on the association between migraine and atrial fibrillation, which is a relevant risk factor for stroke. METHODS We searched Pubmed for 'migraine' AND 'atrial fibrillation' and selected original investigations on the association of migraine and atrial fibrillation for our analysis. Articles without original data, such as guidelines, narrative reviews, editorials, and others were excluded. RESULTS 109 publications were found. 22 were included and analyzed for this review. The population-based ARIC study showed a significant association of migraine with visual aura and incident atrial fibrillation, but not for migraine without aura, compared to non-headache persons (HR 1.30, 95% CI 95% 1.03-1.62, p=0.02) after multivariable adjustment for vascular risk factors. An even larger population-based study in Denmark confirmed this association (OR 1.25, 95% CI 1.16-1.36). Studies investigating patients with ischemic stroke and migraine are methodologically insufficient and provide contradictory results. Ablation therapy for atrial fibrillation in patients with migraine might reduce migraine-attacks, but transient post-ablation new-onset migraine-like headaches in persons without a history of migraine have also been reported. CONCLUSION Population based studies indicate a significant association of migraine with aura and atrial fibrillation. In practical terms, screening for atrial fibrillation in patients who have a long history of migraine might be reasonable, whereas in patients with stroke or other disorders and migraine extensive screening for atrial fibrillation should be performed like in all patients without migraine.