Key result
Brugada syndrome and drug-induced type 1 pattern linked to ~2-fold higher lifetime migraine prevalence.
Why the study?
Following reports of high 1-year migraine prevalence in atrial arrhythmias with DI-type 1 BrP, this study evaluated lifetime migraine prevalence in BrS or DI-type 1 BrP versus controls and sought predictors of underlying BrS/DI-type 1 BrP among migraineurs.
Does Brugada syndrome or drug-induced type 1 Brugada pattern increase the lifetime prevalence of migraine?
Case-Control (n=627)
No
Does Brugada syndrome or drug-induced type 1 Brugada pattern increase the lifetime prevalence of migraine?
Migraine is highly prevalent in patients with Brugada syndrome, necessitating cautious use of certain anti-migraine drugs that may exacerbate the Brugada phenotype.
Answers are grounded in this paper and cite their sources.
Brugada syndrome was associated with higher migraine prevalence; this case-control finding supports cautious anti-migraine drug selection but leaves causality and screening open.
Introduction We have previously reported high 1‐year prevalence of migraine in patients with atrial arrhythmias associated with DI‐type 1 BrP. The present study was designed to determine the lifetime prevalence of migraine in patients with Brugada syndrome (BrS) or drug‐induced type 1 Brugada pattern (DI‐type 1 BrP) and control group, to investigate the demographic and clinical characteristics, and to identify clinical variables to predict underlying BrS/DI‐type 1 BrP among migraineurs. Methods and Results Lifetime prevalence of migraine and migraine characteristics were compared between probands with BrS/DI‐type 1 BrP ( n = 257) and control group ( n = 370). Lifetime prevalence of migraine was 60.7% in patients with BrS/DI‐type 1 BrP and 30.3% in control group ( p = 3.6 × 10 −14 ). On stepwise regression analysis, familial migraine (odds ratio [OR] of 4.4; 95% confidence interval [CI]: 2.0–9.8; p = 1.3 × 10 −4 ), vestibular migraine (OR of 5.4; 95% CI: 1.4–21.0); p = .013), migraine with visual aura (OR of 1.8; 95% CI: 1.0–3.4); p = .04) and younger age‐at‐onset of migraine (OR of 0.95; 95% CI: 0.93–0.98); p = .004) were predictors of underlying BrS/DI‐type 1 BrP among migraineurs. Use of anti‐migraine drugs classified as “to be avoided” or “preferably avoided” in patients with BrS and several other anti‐migraine drugs with potential cardiac I Na /I Ca channel blocking properties was present in 25.6% and 26.9% of migraineurs with BrS/DI‐type 1 BrP, respectively. Conclusion Migraine comorbidity is common in patients with BrS/DI‐type 1 BrP. We identify several clinical variables that point to an underlying type‐1 BrP among migraineurs, necessitating cautious use of certain anti‐migraine drugs.
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Hasdemir et al. (2020) conducted a case-control in Brugada syndrome or drug-induced type 1 Brugada pattern (n=627). Brugada syndrome or drug-induced type 1 Brugada pattern vs. Control group (AVNRT, AV-APs, and pure controls) was evaluated on Lifetime prevalence of migraine (p=3.6 × 10^-14). Lifetime prevalence of migraine was significantly higher in patients with Brugada syndrome or drug-induced type 1 Brugada pattern compared to controls (60.7% vs 30.3%, p=3.6×10^-14).
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