A migraine is a complex neurological event characterized by debilitating pain and associated symptoms like nausea and sensitivity to light and sound. Heart palpitations are the sensation of a racing, pounding, or skipped heartbeat. The simultaneous occurrence of a migraine and heart palpitations is common, and understanding this connection requires examining shared physiological systems, external factors, and the effects of treatment.
Shared Nervous System Pathways
The most direct link between a migraine and altered heart rhythm lies in the Autonomic Nervous System (ANS), which manages involuntary functions like heart rate and the fight-or-flight response. During a migraine, this system can become unbalanced, leading to autonomic dysfunction. This often triggers an overactivation of the sympathetic nervous system, mimicking a stress response that increases heart rate and blood pressure. This systemic response is what a person perceives as palpitations.
The core mechanism of a migraine involves the trigeminovascular system, which releases powerful neurochemicals. One such chemical is Calcitonin Gene-Related Peptide (CGRP), a potent vasodilator released from trigeminal nerve endings. Elevated CGRP levels cause blood vessels to expand and contribute to pain. Its systemic release and influence on blood vessel tone can indirectly affect cardiovascular stability, contributing to the sensation of an altered heartbeat.
The neurotransmitter serotonin is also involved in regulating vascular tone and pain signaling. Fluctuations in serotonin levels, particularly a decrease during an attack, influence the headache mechanism. Since serotonin receptors are present throughout the cardiovascular system, its dysregulation can contribute to rhythm disturbances that manifest as palpitations.
Cardiovascular Effects of Migraine Medications
Paradoxically, the medications used to treat a migraine can often be the source of heart palpitations. Acute treatments like Triptans stop a migraine by targeting specific serotonin receptors and constricting dilated blood vessels in the brain.
However, the receptors Triptans target are also found on coronary arteries, meaning the medication can cause systemic vasoconstriction. This action can lead to side effects such as chest tightness, pressure, or a noticeable change in heart rhythm, which is perceived as a palpitation. While Triptan-related cardiac events are rare, the sensation of an altered heartbeat is common. For this reason, Triptans are generally avoided in patients with pre-existing cardiovascular disease.
Preventative medications, taken daily to reduce migraine frequency, also affect heart function. Beta-blockers, such as propranolol, are commonly prescribed for prevention because they modulate nerve and blood vessel activity. Since these drugs slow the heart rate and lower blood pressure, adjusting the dosage can temporarily cause rhythm irregularities or palpitations as the body adjusts.
Calcium channel blockers are also used as migraine prophylactics and work by affecting the muscles in the heart and blood vessel walls. Changes in the heart’s electrical signaling due to these drugs can be felt as a flutter or skipped beat. When palpitations begin or worsen shortly after a new migraine medication is introduced, it is often a direct pharmacological side effect.
Co-occurring Conditions and Shared Risk Factors
In many cases, migraines and heart palpitations share a common third factor rather than causing each other. There is an established link between migraines, especially those with aura, and certain structural heart conditions. The most recognized is Patent Foramen Ovale (PFO), a small opening between the upper chambers of the heart that failed to close after birth.
While a PFO is present in about 25% of the general population, its prevalence is significantly higher in people who experience migraine with aura, sometimes reaching 46% to 88%. This opening may allow small substances, like vasoactive chemicals, to bypass the lungs and travel directly to the brain, potentially triggering neurological events. Migraine with aura has also been associated with an increased risk of cardiac arrhythmias, such as atrial fibrillation.
Psychological factors and lifestyle issues are shared triggers for both symptoms. Conditions like chronic stress, generalized anxiety, and panic attacks activate the body’s fight-or-flight response, flooding the body with adrenaline. This rush directly causes the heart to beat faster, leading to palpitations, and can simultaneously trigger a migraine attack.
Common lifestyle factors also affect neurological and cardiovascular stability. Dehydration, caffeine withdrawal, and hormonal fluctuations (such as those occurring during the menstrual cycle) are well-known triggers for migraines. These same triggers can also impact the heart’s electrical system, leading to rhythm changes. Addressing these shared stressors can provide relief for both symptoms.
When to Consult a Healthcare Provider
While the co-occurrence of a migraine and heart palpitations is often benign, certain symptoms require immediate medical evaluation. Seek emergency care if palpitations are accompanied by severe symptoms:
- Chest pain
- Shortness of breath
- Profound dizziness
- Loss of consciousness
These symptoms may indicate a serious cardiovascular event.
It is advisable to consult a healthcare provider if heart palpitations are a new or worsening symptom, especially after beginning a new migraine medication. A doctor can evaluate whether the palpitations are a side effect or a sign of an underlying issue. Tracking the timing of your palpitations relative to your migraine attack and medication doses can provide useful diagnostic information. Persistent or recurring palpitations, even without emergency symptoms, warrant professional assessment.