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People with migraine with aura ‘should be offered statins at lower risk thresholds’

GPs should consider offering statins at QRISK2 scores below 10% in people who have migraine with aura, an editorial in the British Journal of General Practice has argued.

NICE currently recommends interventions for primary prevention of cardiovascular disease (CVD) – including the option of taking statins – in people who have a 10% or higher risk of CVD in the next 10 years based on QRISK2.

However, Exeter GP Dr David Kernick says GPs should explain to women who suffer migraine with aura that their 10-year of CVD risk is actually 2.5 times as high as the QRISK2 tool would predict.

And men who experience migraine should be told their risk is 1.5 times their QRISK2 score.

Dr Kernick outlines his case in an editorial in the forthcoming issue of the British Journal of General Practice.

He says the main concern is around an increased risk of ischaemic stroke – overall, people with migraine with aura have been found to have 2.5 times the usual risk for this outcome, rising to seven times as high among women using combined oral contraception and nine times as high among smokers.

According to Dr Kernick, statins should be considered at even lower risk thresholds for younger people and those who have more than 12 attacks a year – while ‘the importance of other risk factors and in particular smoking should be emphasised’.

He says his calculations ’will be imprecise, but are a useful starting point’.

Br J Gen Pr 2015; 65: 571

Readers' comments (5)

  • WTF?Has the whole world gone crazy!Where are the prospective randomised control trials to back this assertion?

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  • The meta-analysis showed that taking a statin for primary prevention extended lifespan by 3 days. Presumably the migraineurs fit into this category.

    I would not take a statin for that sort of benefit.

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  • Push statins at all costs?

    How can I get in bed with pharmaceuticals to get share of profits for this? That's what NICE/this plonker seem to be doing. That's the only assumption I can make.

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  • John Glasspool

    Interesting and odd, as I had assumed the pathogenesis of stroke in migraine was from spasm rather than arterial occlusion by thrombus, in the first instance at least. Is this wrong?

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  • Agree with above. Different mechanism of ischaemia. Must have RCT before changing current guidelines, not after

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