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Association Between Migraine and Ischemic Cardio-Cerebrovascular Disease (CCVD) and Effects of Triptans and Ergotamine on the Risk of Ischemic CCVD in Patients with Migraine in the Korean NHIS-HEALS Cohort

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Abstract

Background and Objectives

Triptans and ergotamine are commonly used to treat migraine, a risk factor for ischemic stroke. This study aimed to investigate the association between migraine and ischemic cardio-cerebrovascular disease (CCVD). Further analyses were performed to examine whether symptom-relieving treatment of migraine with triptans and ergotamine reduces ischemic CCVD in migraineurs.

Methods

Participants from the Korean NHIS-HEALS cohort database were divided into patients reporting headache without migraine (HA), migraineurs who received at least one prescription for triptans or ergotamine (TE), and migraineurs who were prescribed neither triptans nor ergotamine (NTNE). Ischemic CCVDs comprised ischemic cerebrovascular diseases and cardiovascular diseases. Using cox proportional hazards regression models, primary and secondary analysis for risk of ischemic CCVDs was compared.

Results

Among 62,272 patients diagnosed with migraine or HA, men with migraine or HA numbered 14,747 and 8935, respectively, while the numbers of women were 27,836 and 10,754, respectively. The median follow-up was 6.65 years. The overall incidence rate of CCVDs was 4728/38,590 (12.25%) in females and 3158/23,682 (13.33%) in males. Compared with the HA group, the hazard ratios (HRs) (95% CIs) of the TE and NTNE groups for ischemic CCVDs were 1.18 (1.01–1.39) and 1.39 (1.28–1.50), respectively, in males, and 1.22 (1.09–1.37) and 1.53 (1.42–1.65), respectively, in females, after full adjustment for confounding variables. Compared with the NTNE group, the HRs (95% CIs) of the TE group for ischemic CCVDs were 0.86 (0.73–0.999) in males and 0.80 (0.72–0.88) in females.

Conclusions

Migraine increased the risk of ischemic CCVDs in both sexes, and migraineurs treated with triptans and ergotamine were at lower risk of ischemic CCVDs than migraineurs who did not take those medications, especially in women.

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Acknowledgements

We thank Dong Ik Shin, Department of Neurology, Chungbuk National University Hospital for reviewing the contents of this article and providing advice.

Author information

Author notes

  1. Yonghwan Kim and Sang-Jun Shin as the co-first authors equally contributed to this work.

  2. Joungyoun Kim and Hee-Taik Kang as the co-corresponding authors equally contributed to this work.

Authors and Affiliations

  1. Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea

    Yonghwan Kim, Jae-woo Lee, Ye-Seul Kim & Hyo-Sun You

  2. Department of Information and Statistics, Chungbuk National University, Cheongju, Republic of Korea

    Sang-Jun Shin

  3. Department of Artificial Intelligence, University of Seoul, 163 Seoulsiripdaero, Dongdaemun-gu, Seoul, 02504, Republic of Korea

    Joungyoun Kim

  4. Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Hee-Taik Kang

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Correspondence to Joungyoun Kim or Hee-Taik Kang.

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Funding

Hee-Taik Kang received a research Grant from the National Research Foundation of Korea (NRF) grant funded by the Korean government (grant number: 2021R1G1A1006485).

Conflict of interest

Y. Kim, S-J. Shin, J-w. Lee, Y-S. Kim, H-S. You, J. Kim, and H-T. Kang declared no conflicts of interest: no affiliations with or involvement in any organization relevant to the submitted work, no financial relationships with any organizations that might have an interest in the submitted work, and no other relationships or activities that could appear to have influenced the submitted work.

Ethics approval and consent to participate

The study was approved by the medical ethics committee of Chungbuk National University Hospital (CBNUH 2021-12-014) and conducted according to the Declaration of Helsinki. Need for written consent was waived because all data were fully anonymized and provided by the Korean National Health insurance service.

Consent for publication

Not applicable.

Data availability statement

Data used in this research are available if researchers who want to deal with the Korean National Health Insurance Service (NHIS) database get permission from Korean NHIS. The data sets are available through approval and oversight by the Korean National Health Insurance Service [REQ202201018-001(NHIS--)].

Code availability

Not applicable.

Author contributions

All authors made substantial contributions to the acquisition, analysis, or interpretation of data for the work. YK designed the study, managed data, interpreted statistical data analysis, and drafted the manuscript. S-JS managed data, performed the statistical analysis, and wrote the statistical draft. J-wL, Y-SK, and H-SY made substantial contributions to the acquisition, analysis, or interpretation of data for the work. JK and H-TK contributed to concept development, designed the study protocol, and interpreted data. They are the guarantors of this work and, as such, had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Kim, Y., Shin, SJ., Lee, Jw. et al. Association Between Migraine and Ischemic Cardio-Cerebrovascular Disease (CCVD) and Effects of Triptans and Ergotamine on the Risk of Ischemic CCVD in Patients with Migraine in the Korean NHIS-HEALS Cohort. Clin Drug Investig 43, 541–550 (2023). https://doi.org/10.1007/s40261-023-01290-7

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