Women who get migraine headaches may face higher risk of stroke, heart attack, or the need for heart surgery than women without migraines, according to a large long-term U.S. study.

Migraines—intensely painful and often accompanied by nausea, vomiting, and sensitivity to light and sound—have previously been linked with increased stroke risk, but the new study found that they were also linked with other cardiovascular problems.

The study, involving researchers at Harvard T.H. Chan School of Public Health and colleagues, followed more than 116,000 U.S. women who participated in the Nurses’ Health Study II from 1989 to 2011. They found that women with migraines had a 50% greater risk for heart attack, stroke, or surgery to open blocked heart arteries than women without migraines. They also found that women with migraines had a 37% higher risk of dying from a heart attack or stroke during the study period.

Although the study can’t prove that migraines cause heart attack or stroke, “Physicians should be aware of the association between migraine and cardiovascular disease and women with migraine should be evaluated for risk,” said lead author Tobias Kurth in a May 31, 2016 HealthDay article. Kurth is director of the Institute of Public Health at Charité – Universitätsmedizin Berlin and an adjunct professor of epidemiology at Harvard Chan School.

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