For reasons that are not completely understood, women are about three times more likely to experience migraines than men. Research has also shown that migraines are associated with an increased risk of heart attack, stroke and other health complications.

What is the nature of these associations?

Andrea Harriott, MD, PhD

Andrea Harriott, MD, PhD, a neurologist at Massachusetts General Hospital, has spent her career investigating the mechanisms underlying chronic pain, and is focused on how headaches, migraine and stroke impact women’s health.

Using a combination of basic science and community outreach, she is working to answer these questions, raise awareness about the connections between these diseases and address health inequities that Black women face.

She talked more about her upbringing and career path as part of the Black Journey to Neurology INSPIRE series earlier this summer.

Background

Dr. Harriott’s parents immigrated from Jamaica in the 1970s and settled in Baltimore. Her mother is a teacher and her father is a pastor, and during summers he would set up a tent to host members of the community.

She went to Baltimore Polytechnic Institute for high school, where by her junior year she had to choose between biological sciences and engineering. After flipping a coin, she chose biological sciences, but at the time was not sure she wanted to go to college.

“I wanted to join the military after high school,” says Harriott. But a teacher convinced her to apply to Morgan State University, a Historically Black College and University. She ended up receiving a scholarship, which made the decision clear.

“I ended up going to this Historically Black College and University, and really that’s where the framework of science and my love for science actually began,” she explains.

Dr. Harriott became interested in migraines early in graduate school after learning her mentor at the University of Maryland, Michael Gold, PhD, suffered from them.

The cause of migraines became an intriguing mystery that convinced Dr. Harriott to shift her scientific focus away from pain related disorders of the temporomandibular joint, which connects the jaw to the skull.

“Migraines are a painful condition, and I’m working on head and neck pain,” she says. “Why not study them? It seemed like a natural fit.”

About Migraines

Approximately 12%-15% of the population experience migraines, a form of debilitating headache that can last from several hours to days, and often is accompanied by other symptoms such as sensitivity to light and sounds, nausea, vomiting, dizziness and throbbing pain.

One of the telltale signs of a migraine is an abnormal visual event called an aura where someone will see bright spots or lines that can move or grow. Aura can also cause temporary areas of blindness, numbness and difficulty with movements. These symptoms can also be seen in patients suffering from a stroke, says Harriott, making it easy for the two conditions to be confused. Scientists believe auras are caused by a slow electrical wave that moves across the surface of the brain, a process called cortical spreading depression (CSD).

Looking for the Larger Connection

Symptoms of migraines and strokes can sometimes overlap, and it turns out the two conditions could be related. “You’re twice as likely to develop a stroke if you have a history of migraine than if you don’t,” says Dr. Harriott, and that risk increases in young women.

Migraines are also associated with an increased risk of vascular diseases of pregnancy, such as preterm delivery and preeclampsia, which can negatively affect both mother and child.

As a clinician, Dr. Harriott is learning more about these risks and how to mitigate them, as well as the racial disparities that exist within these conditions. Black women have higher rates of stroke than any other racial ethnic group and are less likely to survive pregnancy and childbirth.

Increasing awareness is crucial to prevent misdiagnosis and poor outcomes, says Dr. Harriott. “While it’s important for everyone to know the symptoms of heart attack, stroke and important dos and don’ts, many stroke awareness campaigns are not geared toward women of color,” she explains.

Taking Action

To address this gap, Dr. Harriott is involved in a network called Community Conversations, where she and other doctors connect with Black women in the community to discuss their health in a comfortable environment. “It’s really just a way to create a safe space, to have communication for populations of patients that are not reached,” says Dr. Harriott.

Education and awareness are not only necessary for patients, but for the medical community as well, she says. “Doctors have to know that a woman less than 45 years of age can come into the emergency room with a heart attack or a stroke.”

Resources

• National Institutes of Health
• Office on Women’s Health
• Community Conversations