A recent study published in the Neurology journal has uncovered a possible link between high diastolic blood pressure and an increased likelihood of experiencing migraines in women. Diastolic pressure refers to the blood pressure measurement taken when the heart is resting between beats. The research, released on July 31, 2024, highlighted that women with elevated diastolic blood pressure were 16% more likely to suffer from migraines compared to women with normal diastolic pressure. This finding provides new insight into the complex relationship between cardiovascular health and migraine risk, particularly in women. Surprisingly, the study did not find a significant association between other cardiovascular risk factors, such as diabetes, smoking, obesity, or high cholesterol, and migraines.

Background and Purpose

Led by Antoinette Maassen van den Brink, PhD, from Erasmus MC University Medical Center in Rotterdam, Netherlands, this study sought to explore how cardiovascular risk factors, which are already known to increase the risk of stroke, heart disease, and heart attacks, relate specifically to the incidence of migraines. While previous research has established a link between migraines and an elevated risk of cardiovascular events, much less is known about the reverse: how cardiovascular risk factors might correlate with the development of migraines.

The study involved 7,266 participants —both male and female—aged 67 years on average, with 15% of them having a history of migraines. By examining these participants, the researchers hoped to understand whether well-established cardiovascular risk factors, such as high blood pressure, smoking, obesity, and high cholesterol, had any significant relationship with the likelihood of experiencing migraines.

Specific Focus on Diastolic Blood Pressure

The study's most notable finding was the 16% increased risk of migraine for women with high diastolic blood pressure. After adjusting for multiple variables such as physical activity, education level, and other cardiovascular risk factors, researchers found that for every standard deviation increase in diastolic blood pressure, women were more likely to experience migraines.

Diastolic vs. Systolic Pressure

Interestingly, the study found no significant correlation between systolic blood pressure (the measurement taken during heartbeats) and migraine risk in either men or women. This suggests that the link between migraines and blood pressure is more strongly associated with small blood vessels (which are more affected by diastolic pressure) rather than large arteries, which are more influenced by systolic pressure. This distinction aligns with the hypothesis that migraines may be related to dysfunction in small blood vessels, which are responsible for regulating blood flow to various parts of the brain and other tissues.

Women Show Higher Susceptibility to Migraine with Diastolic Pressure

The study found a significant gender disparity in the relationship between cardiovascular risk factors and migraine occurrence. Specifically, women exhibited a clear association between high diastolic blood pressure and migraine risk in women, while no such relationship was found in men. These findings add to the growing body of evidence that migraine prevalence is higher in women, and they may respond differently to cardiovascular risk factors compared to men.

One reason for these gender differences could be hormonal fluctuations, which have long been linked to migraines. Hormones such as estrogen may have a more profound effect on blood vessels in women, leading to increased susceptibility to migraines, particularly during phases of hormonal change such as menstruation, pregnancy, or menopause.

Role of Small Blood Vessel Dysfunction in Migraine

The results support the theory that small blood vessel dysfunction is linked to migraines, especially in women. Diastolic blood pressure is a reflection of the pressure in the arteries when the heart is resting between beats, which has more to do with the state of small blood vessels. This contrasts with systolic pressure, which reflects the pressure exerted on larger arteries during heartbeats. If small blood vessels do not function properly, they can disrupt normal blood flow, which might contribute to the onset of migraines.

Researchers are still investigating the exact mechanisms behind this relationship, but these findings suggest that managing diastolic blood pressure could be an important consideration for women who suffer from migraines. Treatments or lifestyle changes aimed at improving small blood vessel health could potentially reduce migraine frequency.

Smoking and Diabetes Linked to Lower Migraine Risk—But Not What You Think

In an unexpected twist, the study found that women who were current smokers had 28% lower odds of experiencing migraines, while those with diabetes had 26% lower odds. However, these findings should be interpreted with caution. Maassen van den Brink warned that this does not imply that smoking or diabetes protects against migraines. Instead, the behavior of smoking or having diabetes might alter the way migraines are reported or experienced. For instance, smoking may trigger migraine attacks, which could lead to fewer smokers identifying themselves as long-term migraine sufferers since they might be discouraged from continuing to smoke due to the onset of migraines.

Similarly, people with diabetes may experience different pain pathways or changes in vascular function, which might make them less likely to report migraines. These unexpected associations highlight the complexity of migraine conditions and the need for more detailed research to understand how underlying health conditions and lifestyle factors influence migraine occurrence.

Key Limitations of the Study

The findings of the study offer valuable insights into the relationship between high diastolic blood pressure and migraine risk in women. However, several limitations must be acknowledged to fully understand the scope of the results:

• Age of Participants: The study's focus on an older population, with a median age of 67, raises questions about the generalizability of the findings to younger populations. As migraines are often associated with younger age groups, it remains unclear whether the same relationships between diastolic pressure and migraines would be observed in younger individuals.

• Small Sample of Male Migraineurs: The relatively low number of male participants who reported migraines limited the ability to assess whether similar associations exist between cardiovascular risk factors and migraines in men. This gap highlights the need for studies with larger and more diverse male cohorts.

• Focus on Cardiovascular Risk Factors: While the study thoroughly investigated well-known cardiovascular risk factors, it did not account for other potential factors that may influence migraine occurrence, such as genetic predisposition, stress levels, or sleep quality. These factors could potentially interact with cardiovascular health in ways that impact migraine risk.

• Short-Term Follow-Up: The study examined participants at a single point in time, focusing on existing conditions and migraines rather than tracking changes over time. This cross-sectional design limits the ability to draw conclusions about cause and effect. Longer-term studies are needed to understand how cardiovascular risk factors develop and potentially contribute to migraine onset or progression over the years.

Directions for Future Research

Given the limitations mentioned above, future research should focus on the following areas to provide a more comprehensive understanding of how cardiovascular health and migraine risk intersect:

• Include Younger Populations: Future studies should recruit younger participants, including adolescents and adults in their 20s and 30s, to determine if the relationship between diastolic blood pressure and migraines holds true across the lifespan. This could help determine whether managing cardiovascular risk factors from a younger age could potentially reduce migraine risk.

• Expand to Larger Male Cohorts: It is essential to study larger numbers of male migraine sufferers to understand gender-specific differences in how cardiovascular factors influence migraines. Expanding the male sample size would help clarify whether men experience similar vascular changes related to migraine risk or whether their risk factors differ from women’s.

• Track Longitudinal Data: Following participants over time would allow researchers to better identify cause-and-effect relationships. By tracking how blood pressure, cholesterol, and other cardiovascular risk factors change over the years, researchers could assess whether controlling these factors reduces migraine frequency or severity in the long term.

• Incorporate More Comprehensive Health Metrics: Future studies should explore additional factors that might influence migraines, including hormonal changes, sleep patterns, stress levels, and lifestyle behaviors such as diet and exercise. By broadening the scope of inquiry, researchers can develop a more holistic understanding of what contributes to migraine risk and how cardiovascular health fits into the larger picture.

Key Points for Future Study Designs

• Age Considerations: Enroll participants across a wider age range, particularly focusing on younger groups, to determine the onset and evolution of migraine risks over time.
• Increased Male Representation: Ensure larger male cohorts to adequately assess gender differences in cardiovascular risk factors and their impact on migraines.
• Longitudinal Studies: Implement long-term follow-up studies that track the progression of cardiovascular health and migraine occurrences over several years, providing more concrete evidence on causality.
• Holistic Health Factors: Examine the influence of stress, sleep, and hormonal changes in conjunction with cardiovascular factors to understand their cumulative impact on migraine development.

By expanding research in these areas, future studies could offer greater clarity on how to effectively manage cardiovascular risk factors to prevent or reduce migraines. Understanding these connections more deeply would also pave the way for personalized treatment plans, especially for women who appear to be more susceptible to migraines influenced by diastolic blood pressure.