Atrial fibrillation (AF) rarely develops in patients with migraine, according to a systematic review and meta-analysis that reveals a low prevalence overall.
Six studies met the eligibility criteria, of which three had available prevalence data for patients with migraine with and without aura, and the remaining three for only those with migraine in general. Three cohort studies including a total of 888,784 participants provided prevalence data of migraine patients with and without aura having AF. [Singapore Med J 2026;67:361-367]
In migraine with aura, the pooled prevalence of AF was 1.61 percent (95 percent confidence interval [CI], 0.51‒3.29) compared with 1.32 percent (95 percent CI, 0.17‒3.41) in migraine without aura. Three more studies were included from the analysis of the effect of total migraine on AF, with a pooled prevalence of 1.39 percent (95 percent CI, 0.24‒3.46). Overall, heterogeneity among studies was high (I2, 100 percent).
“[T]he prevalence of migraine with aura is found to be higher than migraine without aura,” the researchers said. “The overall prevalence of AF in the combined cohort as well as in the general, nonstroke population was low.”
Causes
AF is a condition that has several underlying and overlapping aetiologies, but experts agree that one of its triggers is autonomic dysregulation. [Circulation 2002;105:2753-2759; J Cardiovasc Electrophysiol 2003;14:559-564]
Migraine is also associated with neuronal dysfunction, but its exact cause remains unknown. Clinical and experimental evidence suggests that cortical spreading depression significantly correlates with migraine with aura. [J Cereb Blood Flow Metab 2011;31:17-35]
“Cortical spreading depression is a slowly propagated wave of depolarization preceding the inhibition of electrical brain activity, leading to transient chemical, nervous and vascular changes in the brain, which may be related to pain,” the researchers said.
This hypothesis is backed by abnormal electrocardiogram changes observed in patients with migraine attacks. A higher frequency of cardiac arrhythmias is also seen during migraine vs not having migraine. [Headache 1998;38:35-38; Med Sci Monit 2007;13:RA47-49]
“Therefore, the idea of neuronal dysfunction being the reason why migraine, especially migraine with aura, has a higher association with AF seems probable, and this area of interest should be further investigated,” the researchers said.
“Despite the multiple probable theories behind the relationship between migraine and AF, our study showed that prevalence of AF in patients with migraine in the general population was low,” they added.
“Further studies need to be conducted to find out if the effect of migraine on AF is large enough to warrant modification to risk prediction tools, such as the CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,” the researchers said.
Study details
This systematic review and meta-analysis relied on the databases of Embase, PubMed, Scopus, and Cochrane. Cohort or cross-sectional studies, studies including only adult patients, and studies examining the relationship between AF and migraine were identified. Case‒control studies and those that included patients with previous AF or nonmigrainous headache diagnoses were excluded.
The researchers assessed the quality of studies using the Newcastle‒Ottawa Scale. They also used random-effects models in all analyses to account for anticipated heterogeneity in the observational estimates and the I2 statistic to measure heterogeneity between studies.