Estudo da associação entre migrânea e marcadores de doença arterial em mulheres de meia-idade

Migraine is associated with an increased risk of cardiovascular disease, especially in women, but the pathophysiological mechanisms are unknown. The relationship between migraine and arterial disease is uncertain. Obstructive sleep apnea is also associated with cardiovascular disease, but the relationship with headaches is inconclusive. This thesis aims to study the association between migraine and arterial damage markers, the correlation between migraine severity and the degree of vascular impairment, to compare the characteristics of headaches stratified by obstructive sleep apnea diagnosis and to study the correlation between headache and sleep apnea severity. This is a cross-sectional study. We included women, 45 to 65 years without previous cardiovascular events, recruited from 2011 to 2012. We collected secondary data on clinical, and laboratory results, as well ultrasound parameters of carotid arteries, pulse wave velocity and sleep study results. A headache expert neurologist evaluated all participants to assess headache diagnosis and to apply the headache impact test and hospital anxiety and depression scale. The groups were divided into groups of migraine subtypes or obstructive sleep apnea diagnosis. Associations between migraine and arterial disease markers (intima-media thickness > 0.9mm [carotid thickening], focal stenosis > 1.5mm [atherosclerotic plaque] and pulse wave velocity ≥ 10m/s [arterial stiffness]) were studied by multivariate analysis, which was also used to study the association between obstructive sleep apnea and headache characteristics (quality, frequency and severity). Correlation coefficients were also calculated. We included 277 women (lost cases = 9%), median age = 57 (52—61) years. Migraine was diagnosed in 112 participants (40%) and 46 women had migraine with aura (17%). Compared to women without migraine, anxiety and depression were more frequent in association with migraine. Women with migraine with aura were younger and had more diagnosis of hypertension and carotid thickening, whereas participants with migraine without aura had fewer atherosclerotic plaques and arterial stiffness. Migraine with aura increased the risk of carotid thickening (OR = 7.1, 95% CI 1.1—48.5) and migraine without aura was associated with a low risk of atherosclerotic plaques (OR = 0.28, 95% CI 0,08—0.99) and arterial stiffness (OR = 0.39, 95% CI 0.19—0.79). There was no correlation between migraine severity and arterial damage measurements. Obstructive sleep apnea was diagnosed in 112 women (40.1%). The occurrence of migraine or any headache and the characteristics of headaches were not different comparing women with and without sleep apnea. The severity of apnea was not correlated with the occurrence or severity of the headache. In middle-aged women, migraine with aura is associated with an increased risk of carotid thickening. Migraine without aura is associated with a lower risk of atherosclerotic plaques and arterial stiffness. The severity of these headaches does not correlate with the degree of arterial damage. Obstructive sleep apnea is not associated with the occurrence, characteristics or severity of headache.