Migraine Headache and Ischemic Stroke Risk: An Updated Meta-analysis

Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md, USA.
The American journal of medicine (Impact Factor: 5). 07/2010; 123(7):612-24. DOI: 10.1016/j.amjmed.2009.12.021
Source: PubMed


Observational studies, including recent large cohort studies that were unavailable for prior meta-analysis, have suggested an association between migraine headache and ischemic stroke. We performed an updated meta-analysis to quantitatively summarize the strength of association between migraine and ischemic stroke risk.
We systematically searched electronic databases, including MEDLINE and EMBASE, through February 2009 for studies of human subjects in the English language. Study selection using a priori selection criteria, data extraction, and assessment of study quality were conducted independently by reviewer pairs using standardized forms.
Twenty-one (60%) of 35 studies met the selection criteria, for a total of 622,381 participants (13 case-control, 8 cohort studies) included in the meta-analysis. The pooled adjusted odds ratio of ischemic stroke comparing migraineurs with nonmigraineurs using a random effects model was 2.30 (95% confidence interval [CI], 1.91-2.76). The pooled adjusted effect estimates for studies that reported relative risks and hazard ratios, respectively, were 2.41 (95% CI, 1.81-3.20) and 1.52 (95% CI, 0.99-2.35). The overall pooled effect estimate was 2.04 (95% CI, 1.72-2.43). Results were robust to sensitivity analyses excluding lower quality studies.
Migraine is associated with increased ischemic stroke risk. These findings underscore the importance of identifying high-risk migraineurs with other modifiable stroke risk factors. Future studies of the effect of migraine treatment and modifiable risk factor reduction on stroke risk in migraineurs are warranted.

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Available from: Saman Nazarian
    • "Chronic migraine is a common, disabling illness whose mechanism of pathogenesis remains to be discovered. Studies have shown that migraines are associated with increased risk of both ischemic [1] and hemorrhagic stroke [2], suggesting a potential vascular role in the etiology of this condition. Furthermore, it has been suggested that variations in the anatomical structure of Circle of Willis (COW), an important source of collateral blood flow in the brain, may contribute to the pathomechanism of migraine [3] [4]. "
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    ABSTRACT: Several studies have attempted to investigate whether variations in the Circle of Willis (COW) are more common in migraine patients and whether the subsequent changes in perfusion may contribute to the pathomechanism of migraine. However, studies are not in agreement as to whether or not there is an increased prevalence of COW variations in migraineurs. To determine if migraine headaches are associated with variations in morphology of the COW. A systemic search of the major electronic databases was performed for articles studying the association of variations in the COW and migraine. Data on the prevalence of variations in patients with migraine were extracted and pooled into the meta-analysis. A total of four articles (n=807 patients) were deemed eligible for the meta-analysis. Migraine, regardless of subtype, was found to be associated with variations in the COW (OR=2.27, 95%CI 1.53-3.38, p<0.0001). An incomplete posterior circle (OR=2.60, 95%CI 1.79-3.76, p<0.00001) was found to be more strongly associated with migraine than an incomplete anterior circle (OR=2.01, 95%CI 1.15-3.53, p=0.01). In sub-group analysis, migraine with aura was found to be associated with both an incomplete posterior (OR=3.55, 95%CI 2.25-5.59, p<0.00001) and an incomplete anterior circle (OR=2.35, 95%CI 1.20-4.62, p=0.01). Migraine without aura was found only to be associated with an incomplete posterior circle (OR=2.10, 95%CI 1.39-3.17, p=0.0004). Migraine is associated with anatomical variations in both the anterior and posterior portions of the COW. However, larger prospective trials are needed to determine the true prevalence of variations and their pathological significance. Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
    No preview · Article · Jun 2015 · Neurologia i neurochirurgia polska
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    • "Notably, there is growing evidence that migraine is an independent risk factor for ischemic stroke (Etminan et al. 2005; Lampl & Marecek 2006; MacClellan et al. 2007; Moskowitz & Kurth 2007; Pezzini 2010; Spector et al. 2010; Tzourio et al. 1995; Carolei et al. 1996). In recent meta-analyses; migraine, particularly those associated with aura, significantly increased the risk of stroke by twofold (Etminan et al. 2005; Spector et al. 2010). Furthermore, this association was most profound in women, persons aged 45 and younger, and those taking oral contraceptives (Etminan et al. 2005). "
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    ABSTRACT: In a recent meta-analysis migraine was associated with a two-fold increase in stroke risk. While the mechanism driving this association is unknown, one intriguing hypothesis is that migraineurs are genetically predisposed to developing ischemic stroke. Mutations in the ATP1A2 gene are implicated in familial hemiplegic migraine type II and increase the severity of ischemic brain injury in animal models. To further explore these observations, we assessed the association between ATP1A2 polymorphisms, migraine, and the risk of ischemic stroke in participants of the Genetics of Early-Onset Stroke Study, a population-based case-control study of ischemic stroke among men and women aged 15-49. Using responses to a headache symptoms questionnaire, subjects were classified as having no migraine, or migraine with or without visual aura. Evaluating a total of 134 ATP1A2 polymorphisms genotyped using a combination of Illumina platforms (Cardiovascular Gene-centric 50 K SNP Array and HumanOmni1-Quad_v1-0_B Bead Chip), only one polymorphism (rs2070704) demonstrated a nominally significant association with stroke in an age-, gender-, ethnicity-adjusted model (OR = 0.83, 95% CI = 0.71-0.98, p = 0.025) and in a vascular risk factor model adjusting for age, gender, ethnicity, hypertension, diabetes, smoking, and myocardial infarction (OR = 0.74, 95% CI = 0.63-0.89, p = 0.001). Ethnicity-stratified analyses demonstrated a significant association for rs2070704 among African-Americans (OR = 0.68, 95% CI = 0.53-0.90, p = 0.005) but not Caucasians (OR = 0.82, 95% CI = 0.64-1.04, p = 0.107). These associations were unchanged when migraine subtypes were included as co-variates. We did not observe an association between ATP1A2 polymorphisms and migraine. While our results do not demonstrate a strong relationship between ATP1A2 polymorphisms and migraine associated stroke risk, the results are hypothesis generating and indicate that an association between ATP1A2 polymorphisms and stroke risk may exist. Additional studies are required.
    Full-text · Article · Dec 2013 · SpringerPlus
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    • "This matter is especially crucial in emergency situations where thrombolytic therapy may be withheld in patients with a history of migraine because the treating doctor suspects SM and not ischaemic stroke. This problem is highly relevant in migraine patients since this patient group has been associated with a higher risk of ischaemic stroke [10] [11]. In this study, we aimed to examine the rate of thrombolytic therapy in young stroke patients with and without a history of migraine. "
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    ABSTRACT: Background. Migraine is prevalent in young patients and a frequent stroke mimic. To distinguish stroke mimics from true stroke can be difficult, and there is a possibility of misdiagnosing a stroke as a migrainous attack in patients with migraine. We aimed to investigate if a history of migraine affects the rate of thrombolytic therapy in young stroke patients. Methods. All patients below 50 years of age admitted in the period 2006-2013 to the Bergen Stroke Centre with acute ischaemic stroke were included. The rate of thrombolytic therapy in patients with migraine was compared to patients with no history of migraine. A multivariate analysis was performed to adjust confounding factors. Results. A total of 170 young stroke patients were enrolled, 49 with migraine and 121 with no migraine. In total, 10.2% of young patients with migraine received thrombolytic therapy, compared with 26.5% of young patients with nomigraine (P = 0.02). Migraine was associated with a low rate of thrombolytic therapy when adjusting for possible confounding factors (OR 0.19 CI: 0.05-0.72, P = 0.02). Conclusion. Migraine is associated with a low rate of thrombolytic therapy in young patients admitted with acute ischaemic stroke. Migraine patients admitted with acute ischaemic stroke are at risk of maltreatment.
    Full-text · Article · Nov 2013 · Stroke Research and Treatment
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