The headache is so severe. The patient feels so sick. He cannot get out of bed. He cannot eat. He cannot see. All sounds make everything worse. He has terrible nausea and throws up all of his last meal and then start retching bile.

Can migraine headaches lead to death, because a migraine sure feels like death?

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.

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Migraine headaches do not usually cause death or brain damage directly. Young women who have migraine with aura, who smoke, and are on a high estrogen dose are at risk of stroke. Migraine with aura can result in an increased risk of death due to cardiovascular disease.

Additional questions.

Has the risk of death ever been studied for migraine patients?

A large-scale 2020 study, Trusted Source, in women found no link between migraine and all-cause death. This included migraine with or without aura or a history of previous migraine. The term “all-cause death” refers to all deaths that occur in the population, regardless of the cause.

This study was performed by Rohmann, JL, Rist, PM, Buring, JE, Kurth, T. “Migraine, headache, and mortality in women: a cohort study,” The Journal of Headache and Pain volume 21, Article number: 27 (2020).

Abstract

Migraine carries a high global burden, disproportionately affects women, and has been implicated as a risk factor for cardiovascular disease. Migraine with aura has been consistently associated with increased risk of cardiovascular mortality.

However, published evidence on relationships between migraine or non-migraine headache and all-cause mortality is inconclusive. Therefore, we aimed to estimate the effect of non-migraine headache and migraine as well as migraine subtypes on all-cause and cause-specific mortality in women.

Methods

In total, 27,844 Women’s Health Study participants, aged 45 years or older at baseline, were followed up for a median of 22.7 years. We included participants who provided information on migraine (past history, migraine without aura, or migraine with aura) or headache status and a blood sample at study start.)

An endpoints committee of physicians evaluated reports of incident deaths and used medical records to confirm deaths due to cardiovascular, cancer, or female-specific cancer causes. We used multivariable Cox proportional hazards models to estimate the effect of migraine or headache status on both all-cause and cause-specific mortality.

Results

Compared to individuals without any headache, no differences in all-cause mortality for individuals suffering from non-migraine headache or any migraine were observed after adjustment for confounding (HR = 1.01, 95%CI, 0.93–1.10 and HR = 0.96, 95% CI: 0.89–1.04). No differences were observed for the migraine subtypes and all-cause death.

Women having the migraine with aura subtype had a higher mortality due to cardiovascular disease (adjusted HR = 1.64, 95%CI: 1.06–2.54). As an explanation for the lack of overall association with all-cause mortality, we observed slightly protective signals for any cancer and female-specific cancers in this group.

What is the relationship between migraine and heart disease?

The American Migraine Foundation (AMF) said that migraine can increase the risk of stroke, coronary events, and other related death by roughly 50%. It may also double the risk of heart disease from reduced blood flow.

It is not well understood how migraine and cardiovascular problems link together, but it may be due to inflammation, altered platelet and blood clotting, and atherosclerosis (build up of fat in arterial walls.)

The AMF states that stroke occurs more frequently in people who have or previously had migraine.

Can migraine cause permanent brain damage?

The American Headache Society stated that “migraine does not result in long-term brain damage”. The organization references two population studies that took brain scans of people with and without migraine to study the long-term effects on the brain.

After 9–10 years, researchers found white lesions on the brain in some individuals with migraine, but these changes had no link to any changes in cognitive or brain function.

The AMF also confirms that research has found white matter lesions in some people with migraine, but that these lesions usually have no link with cognitive decline or neurological problems.

The “white matter lesions" are called “T2 microvascular disease” by neurologists or neuroradiologists.

What are the complications of migraine?

Status migrainosus

This is a severe, unrelenting migraine lasting more than 72 hours which renders the migraine patient in severe pain, disabled in bed, nauseated and vomiting till dehydrated.

The pain is usually on one side of the head, throbbing, severe (>7 of 1-10), with associated inability to be up, and sensitivity to light and sound. A migraine lasting 72 hours has not responded to treatment, and may be due to late application of a triptan, or use of over-the-counter drugs if the patient doesn’t have a doctor to prescribe effective treatment.  

Migrainous infarction

This is the occurrence of an ischemic stroke during the migraine attack.  Migrainous infarction is a stroke that occurs during a migraine with aura attack. Strokes may be differentiated into hemorrhagic (presence of fresh red blood in the brain) or ischemia (lack of blood in the brain) due to either a small blood clot in the artery (embolus) or a closed off artery.

Migraine may cause an ischemic stroke, or infarction, during a migraine with aura. An ischemic stroke happens when a blood clot causes a blockage or narrowing in an artery that connects to the brain.

Persistent aura without infarction

This is a rare type of migraine with aura event. The migraine aura “persists” in persons with this type of migraine. Aura occurrence may last for months or years, with no signs of stroke. These people need to be neurologically assessed also.

Migralepsy or Migraine aura-triggered seizure

Rarely, a migraine attack with aura will trigger a seizure. These typically occur during or within 1 hour after the initial migraine attack. The neurologist may offer you a seizure medication that treats both migraine and seizure such as topiramate or valproic acid.

Warning headache symptoms which should be evaluated.

Thunderclap headache: severe onset headache that reaches peak intensity within a few minutes. These may be benign but may also signify aneurysmal rupture.

Positional headache: Headache that changes in intensity with positional change, such as standing up from lying down.

Exertional headaches that come with a cough, sneeze, or straining at the stool.

New onset headaches, especially in persons older than 50 or persons with previous cancer or blood clotting disorder.

Change in headache pattern, such as an increase in frequency or intensity of headaches.

The occurrence of unusual symptoms with headache, such as:

weakness on one side of the body

change in consciousness

change in vision

difficulty walking

fever

chills

weight loss

night sweats

In summary:

Migraine headaches feel severe but are not usually life threatening and are unlikely to cause death or long-term brain damage.

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All the best.

Britt Talley Daniel MD