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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