Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Burden of Syncope in Patients With Migraine

Modifiable risk factors for syncope in patients with migraine include body mass index (BMI) and tea intake, a new study found. Participants were recruited from a headache clinic and provided information of lifestyle, comorbidity, syncope, and completed the MIDAS and HADS questionnaires. Among the findings:

  • Underweight, regular tea intake, diabetes mellitus, and migraine with aura were associated with increased syncope risks.
  • Preliminary results showed that rs11172113 in LRP1 was associated with syncope risks.
  • Comorbid syncope in patients with migraine was associated with risks of depression.


Kuan AS, et al. Risk factors and psychological impact of syncope in migraine patients. [Published online ahead of print July 15, 2019]. Cephalalgia. doi: 10.1177/0333102419865253.


A classic paper of the late James Lance and Selby published in 1960 reviewed clinical features of 500 patients with migraine (Selby and Lance. J Neurol Neurosurg Psychiatry 1960; 23:23-32). Ten patients reported syncope, or 2%. The current evaluation found 7% of 1,593 migraine patients with syncope, which shows that syncope is not uncommon in those with migraine, higher in people with migraine who are female, diabetic, tea drinkers, and those with aura. There appears to be an association with significant depression as well. Appel, Kuritzky, and colleagues documented dysautonomia in those with migraine in a case-controlled trial published in 1992 (Appel, Kuritsky et al. Headache. 1992;32:10-17). The current report suggests that greater attention to syncope and dysautonomia is clinically indicated, if only as an alert for potentially severe comorbid depression. Association does not prove causation, and further study is indicated to evaluate potential etiologic links for these findings. —Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH