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To the Editor: Dr Kurth and colleagues¹ reported the results of their study of the association between migraine and risk of cardiovascular disease (CVD). We believe that several factors limit the interpretability of their findings.

While the authors state that exposure misclassification would have led to underestimation of the migraine-CVD association, this is not certain. There were at least 2 types of potential errors in classifying study participants. First, participants were asked whether they had ever experienced a migraine headache or had experienced a migraine headache during the past year. An affirmative response led to further questioning and classification. Women who did not recognize their headaches as being migraines would have been misclassified as having no history of migraine, which may account for the study's low prevalence of active migraine (13.0%). Many patients who believe they have sinus headache actually meet International Headache Society criteria for migraine.² Second, the question . . . [Full Text of this Article]

William B. Young, MD
william.b.young@jefferson.edu

James W. Shaw, PhD, PharmD, MPH
Department of Neurology
Thomas Jefferson University
Philadelphia, Pa

RELATED LETTER

Association Between Migraine and Cardiovascular Disease in Women—Reply
Tobias Kurth, J. Michael Gaziano, Nancy Cook, Giancarlo Logroscino, Hans-Christoph Diener, and Julie E. Buring
JAMA. 2006;296(22):2677-2678.
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