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New research suggests that there’s a difference between people who have migraines a lot and those who have them less often: The most frequent sufferers are in worse health overall, poorer and more depressed.

The finding comes from a study of nearly 12,000 people with headaches that were labeled either episodic, if they occurred no more than 14 days a month, or chronic, if they occurred 15 or more days a month.

Those with chronic migraines made a lot less money, were less likely to work full-time and were nearly twice as likely to have a job-related disability as the other headache patients.

The chronic sufferers were also twice as likely to experience other problems, such as depression, anxiety and chronic pain. They were 70 percent more likely to have had a stroke, and the researchers linked these chronic migraine patients to higher rates of such diseases as asthma, high blood pressure and diabetes.

The findings, the researchers say, could be used to figure out how people with episodic migraines develop chronic forms of the condition.

The study findings were published online in the Journal of Neurology, Neurosurgery and Psychiatry.

Hormone replacement therapy does not lower the odds of heart trouble in women who take the regimen to ease hot flashes and other symptoms of menopause, a new study reports.

In fact, the researchers say, it will probably elevate the risk for heart attacks for the first two years of use.

“There was no protective effect after women first started hormone therapy,” said Dr. James Liu, chairman of obstetrics and gynecology at MacDonald Women’s Hospital, University Hospitals in Cleveland, who was not involved with the study. “There may be some benefit later on, but it’s subtle,” he added.

The study reported that women who started taking hormone therapy within 10 years of menopause and who had been taking it for six years might derive some heart-protective effects, but the protection did not reach statistical significance.

No protection was found for women who started hormone therapy at least 10 years after menopause.

The findings, published in the Feb. 15 issue of Annals of Internal Medicine, do not change any current recommendations regarding the widely debated use of hormone therapy, the researchers said.

“If women are thinking about using hormone therapy for menopausal symptoms, they should use the lowest dose and for the shortest duration possible,” said the study’s lead author, Sengwee Darren Toh, an instructor in population medicine at Harvard Medical School in Boston. Toh worked at the Harvard School of Public Health when the study was conducted.

The findings stem from a new analysis of data from the Women’s Health Initiative (WHI), a large, government-sponsored study. Earlier reports from the WHI showed an overall elevated risk for coronary heart disease among women taking estrogen-plus-progestin therapy, called combined hormone therapy.

However, much debate has circulated around whether the risk differs depending on when women start taking the therapy in relation to when they entered menopause.

The so-called “timing hypothesis” has postulated that heightened risk might not exist for women at the younger end of the spectrum.

Originally, the WHI data was analyzed according to the number of women assigned to each arm — whether they were taking hormones or placebos — and did not take into account people who stopped taking the therapy or who crossed over to another arm, Liu explained.

And about 40 percent of the 16,000-plus women participating in the part of the study examining hormone use did not take their assigned treatment, a proportion that increased over time.

“We need to account for this noncompliance if we want to estimate how the effects of hormone therapy on coronary heart disease change over time,” Toh said.

In their analysis, Toh and his colleagues found that, overall, women who took combined hormone therapy for the first two years of the study had more than double the risk for heart attack and other coronary problems.

The increased risk was 69 percent among those taking hormone therapy for eight years.

Among women who started hormone therapy within a decade of menopause, the risk was raised just 29 percent, not considered statistically significant. Over the first eight years of use, the risk for heart attacks was 36 percent lower in this group, the study reported.

“Our paper suggests that both timing of initiating and time since initiation are important aspects to consider when we discuss the effects of hormone therapy on heart disease risk,” Toh said.

SOURCES: Sengwee Darren Toh, Sc.D., instructor, population medicine, Harvard Medical School, Boston; James Liu, M.D., chairman, department of obstetrics and gynecology, MacDonald Women’s Hospital, University Hospitals, Case Western Reserve University, Cleveland

People who are enthusiastic and content are less likely to develop heart disease than less happy people, researchers from Columbia University report.

In this prospective study of the relationship between happiness and heart disease, researchers concluded that if everyone did more of the things that made them happy, they could significantly reduce their risk of heart attack and angina.

“We were excited to discover in a large population-based sample of adults that the tendency to express positive emotion predicted fewer heart attacks across a period of 10 years,” said lead researcher Karina Davidson, director of Columbia’s Center for Behavioral Cardiovascular Health.

“The study suggests that those people who are happier have heart-protective outcomes,” she added.

Davidson speculated that several factors may combine to producing this effect. Happier people tend to sleep better and to practice more heart-healthy behaviors, she said.

“But they may also be physiologically different than those of us who are more unhappy,” Davidson said.

In addition, these people tend to have less stress in their lives and handle the stress they do have better than less happy people, she added.

The report is published in the Feb. 18 issue of the European Heart Journal.

For the study, Davidson’s team followed 1,739 men and women for 10 years. These people all participated in the 1995 Nova Scotia Health Survey. At the start of the study, everyone had their risk for heart disease assessed.

In addition, researchers looked for symptoms of depression, hostility, anxiety and the expression of positive emotions — known as “positive affect.” This is defined as the experience of pleasurable emotions, such as joy, happiness, excitement, enthusiasm and contentment, according to Davidson.

The researchers found that over the study period the happier someone was, the less likely he or she was to develop heart disease. In fact, for every point on a five-point scale that measured positive affect, the risk of heart disease dropped 22 percent.

However, unhappy people had a 22 percent increased risk of having a heart attack or chronic chest pain, compared with those who were somewhat happy. These somewhat happy people also had a 22 percent increased risk for heart problems compared with people who were moderately happy, the researchers noted.

People who were generally happy, but had a few symptoms of depression, did not see these symptoms increase their lowered risk for heart disease, Davidson added.

Davidson noted that she is involved in a clinical trial to test whether changing people’s happiness level improves their heart health.

“In the meantime, it is good for one’s quality of life and mental health to engage in happy behaviors or things that give you pleasure on a daily basis — and many of us here in North America don’t do that,” she said.

Dr. Gregg C. Fonarow, professor of cardiology at the University of California, Los Angeles and co-director of the UCLA Preventative Cardiology Program, said that “negative emotions such as depression, anxiety and anger have been shown to be associated with increased risk of cardiovascular events and mortality.”

Some, but not all previous studies, have suggested that positive affect is associated with lower risk of disease and improved clinical outcomes, he added.

“This new, large population-based study suggests that positive affect is associated with a reduced risk of coronary heart disease over 10 years independent of other cardiovascular risk factors and independent of depression and other negative affects,” Fonarow said.

“These findings are intriguing. The clinical significance will depend on whether it can be subsequently shown that interventions designed to increase positive affect can lower the risk of cardiovascular disease,” he added.

However, while maintaining a positive affect may be one factor associated with a lower risk of cardiovascular disease, regular exercise, not smoking, a healthy diet and maintaining optimal blood pressure, cholesterol levels and body weight are well-established and essential, Fonarow noted.

SOURCES: Karina Davidson, Ph.D., Herbert Irving Associate Professor of Medicine & Psychiatry, and director, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles, and director, Ahmanson-UCLA Cardiomyopathy Center, and co-director, UCLA Preventative Cardiology Program