Sex‐specific differences in the relationship between AHA Life's Essential 8 factors and migraine disorders: A cross‐sectional evaluation in ELSA ‐Brasil study

Objectives To evaluate the associations between the Life's Essential 8 (LE8) factors proposed by the American Heart Association and migraine disorders in the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil). Background There is limited information about the relationship of cardiovascular/cerebrovascular risk factors with migraine types, severity, and sex‐specific differences. Methods The LE8 factors and migraine types (no migraine, migraine without aura [MWO], and migraine with aura [MWA]) and severity were cross‐sectionally evaluated based on information from wave 2 (2012–2014) of the ELSA‐Brasil. The LE8 factors' metrics were computed following the American Heart Association's scoring system. Migraine diagnoses were based on the ICHD‐3 criteria. Sociodemographic‐ and preventive medication use–adjusted odds ratios (aORs) with a 95% confidence interval (CIs) are reported for the associations between LE8 factors adherence levels (low [reference], moderate, and high) and migraine type, severity (defined as attack frequency ≥ 15 days/month [reference: <15 days/month]), and sex. Results Of 4312 participants (mean age: 55.1 years, SD ± 8.9; 54.3% [2342/4312] female), MWO and MWA were identified in 19.3% (835/4312) and 10.6% (460/4312) of participants, respectively. Low, moderate, and high adherence to the LE8 total factors were identified in 11.8% (511/4312), 74.0% (3189/4312), and 14.2% (615/4312) of participants, respectively. Overall, compared to no migraine, high adherence to the LE8 total score was associated with a lower occurrence of MWA [aOR: 0.36 (95% CI: 0.23, 0.55)], MWO [aOR: 0.56 (95% CI: 0.40, 0.78)], and severity [aOR: 0.46 (95% CI: 0.26, 0.82)]. Among females, high adherence to physical activity, sleep health, body mass index, blood lipids, and blood pressure was associated with a lower prevalence of MWA, whereas physical activity and nicotine exposure were associated with a lower prevalence of MWO. Among males, high adherence to nicotine exposure was associated with increased odds of MWO, whereas high adherence to diet and blood lipids was associated with higher and lower odds of frequent headache attacks, respectively. Conclusion In the ELSA‐Brasil study, high adherence to the LE8 total score was associated with lower occurrence of migraine disorders and severity, with type‐, severity‐, and sex‐specific associations. The cross‐sectional design precludes causal inferences, and further investigations are warranted to evaluate the clinical utility of the LE8 framework for reducing migraine burden, particularly in females.