Abstract Background Angina with Non-Obstructive Coronary Arteries (ANOCA) is a commonly underdiagnosed disease characterized by chronic angina, predominantly due to the presence of coronary microvascular and/or vasomotor dysfunction (CMVD). Endothelial dysfunction links the pathogenesis of migraine and CMVD. However, the effects of migraine on CMVD prevalence in ANOCA patients remains largely unexplored. Methods A prospective registry-based study of ANOCA patients (50% stenosis in major vessels) who underwent invasive coronary functional testing (ICFT) using Doppler or Thermodilution method for the evaluation of CMVD between 2020 and 2024 was used to examine the clinical characteristics, angina presentation, and CMVD endotypes in ANOCA patients with migraine compared to those without. The presence of migraine was determined via questionnaire given to patients asking if they were diagnosed by a provider and/or active on migraine medication. CMVD was defined as endothelial-independent (coronary flow reserve CFR 2.5 to adenosine), endothelial-dependent (coronary blood flow CBF 50%, and or change in coronary diameter CD 0% to 54mcg IC acetylcholine) and epicardial spasm (90% constriction to 100mcg IC acetylcholine). Angina, function, and symptoms were assessed via validated questionnaires outlined in Table 1. Results Among 394 ANOCA patients, 86 (22%) had a history of migraine (Table 1). The group with migraine was younger (p=0.003) and predominantly female (94% vs. 86%, p=0.04). The group with migraine also showed a higher prevalence of angina at rest compared to ANOCA patients without migraine (p=0.034). Further, ANOCA patients with migraine had worse angina as measured by the SAQ-7 (p0.001), and more severe shortness of breath as measured by the UCSD-SOB (p=0.003). ICFT revealed a lower prevalence of endothelial-independent CMD defined as CFR2.5 (p=0.002), whereas mean CFR was not different between groups. ANOCA patients with migraine had a higher prevalence of epicardial spasm (p=0.022). There was no difference in prevalence of endothelial dependent CMD between groups. Conclusion Patients with ANOCA diagnosed with migraine experience more severe angina and higher rates of coronary vasospasm. Our results suggest that migraine may be a risk factor for coronary vasospasm in ANOCA patients. Further research is needed to identify a mechanistic link between migraine and CMVD.
Almanzar et al. (Sat,) studied this question.