Abstract Body (Do not enter title and authors here): The extent to which migraine is associated with cardiovascular events may differ across age, gender, racial and ethnic subgroups.

The current study uses the migraine cohort from the Headache Centers of Excellence VHA Headache Cohort. Migraine cases include veterans who had an International Classification of Disease-9/10 code of migraine in the VHA electronic health record between 2008-2023. Controls had no headache ever coded in their VHA electronic health record, and were matched on age, gender, race, ethnicity, and point of care the year of cohort entry (defined as the first year in which headache was diagnosed for the migraine group). Baseline cardiovascular events were extracted from the VHA electronic health record using validated algorithms from 6 months prior to cohort entry to 12 months following cohort entry. Separate logistic regression models evaluated the relationship between migraine vs. matched control and each cardiovascular outcome separately in the following subgroups: gender (men and women), age (18-49 and 50+), race (White and Black), and ethnicity (Non-Hispanic and Hispanic).

The cohort included 668,968 individuals with migraine and 1,337,937 non-headache controls. Overall, subgroup analyses found the strongest relationships between migraine (vs. matched control) and cardiovascular outcomes in younger adults (aged 18-49): ischemic stroke OR = 3.62, 95% CI = 3.33, 3.94; transient ischemic attack OR = 9.0, 95% CI = 7.65, 10.54; Notably, migraine was associated with higher odds of hemorrhagic stroke for younger adults (OR = 4.30, 95% CI =3.27, 5.66), but lower odds of hemorrhagic stroke in adults aged 50+ (OR = 0.28, 95% CI = 0.25, 0.31). An exception is acute myocardial infarction (MI), where the strongest relationship betwen migraine and acute MI was observed in adults aged 50+ (OR = 1.69, 95% CI = 1.57 1.83). Migraine (vs. matched control) was associated with slightly higher odds of heart failure among White patients (OR = 1.28, 95% CI = 1.23, 0.86), but slightly lower odds of heart failure among Black patients (OR = 0.92, 95% CI = 0.86, 0.9. ORs for cardiovascular events were relatively similar (e.g., within 1.0 OR) across gender, racial and ethnic groups.

This study shows that age is a particularly important factor in understanding the relationship between migraine and cardiovascular events.