C-32 | Angina with No Obstructive Coronary Artery Disease and Migraines

Coronary microvascular dysfunction (CMD) and coronary vasospasm are the predominant pathophysiological mechanisms causing angina in patients with no obstructive coronary artery disease referred to as ANOCA. ANOCA and migraines more commonly affect women and are both associated with vasomotor abnormalities. However, little is known on the association between migraines and anginal symptoms and CMD in patients with ANOCA. In a prospective registry, among ANOCA patients (defined as angina and <50% stenosis in the major epicardial vessels) we examined differences in anginal symptoms in patients with and without migraine history based on Canadian Cardiovascular Society (CCS) angina class, Seattle Angina Questionnaire-7 (SAQ-7), and University of California San Diego Shortness of Breath Questionnaire (UCSD SOB) scores. Doppler-based CFR measures were compared in patients with coronary functional angiography (CFA). Differences between patients with and without migraines were analyzed with t-tests and Wilcoxon rank sums for normally and non-normally distributed variables respectively. Among the 759 ANOCA patients, 97.2% were female and 24.6% patients had a history of migraines. Patients with migraines had a higher prevalence of prediabetes, heart failure with preserved ejection fraction (HFpEF) and vasospastic angina compared to those without migraines. SAQ-7 scores were significantly lower (41.6 ± 20.91 vs. 47.7 ± 20.62 p=0.001) and UCSD SOB score was significantly higher (32.8 ± 24.30 vs. 28.9 ± 24.1, p= 0.028) in patients with migraines indicating worse angina and SOB compared to without. No significant difference in CCS angina class between groups. Among the 228 ANOCA patients who underwent CFA, 34.8% had migraines and there was no significant difference in CFR. ANOCA patients with a history of migraines have more vasospastic angina and experience worse anginal and SOB symptoms supporting the overlapping vasomotor abnormalities that characterize these disorders. We did not find a difference in CFR; however, further research is needed to understand whether microvascular and epicardial vasospasm are associated with migraines among ANOCA patients.