The effectiveness of aspirin for migraine prophylaxis: a systematic review

Baena, Cristina Pellegrino; D'Amico, Raíssa Campos; Slongo, Helena; Brunoni, André R.; Goulart, Alessandra Carvalho

doi:10.1590/1516-3180.2016.0165050916

Cited by 16 publications

(21 citation statements)

References 33 publications

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“…Although not recommended for migraine prophylaxis in current headache guidelines, 173 antiplatelet medications (aspirin and thienopyridines, clopidogrel, and ticagrelor) have been studied in persons with migraine, including in those with PFO or who are status post closure procedures (Table 3). 174‐181 Given the paucity of randomized controlled trials (RCT) and the inconsistency of results, additional research, especially in persons with MWA and PFO, is indicated. The 3 RCT of percutaneous PFO closure in persons with migraine (MIST, 182 PRIMA, 183 and PREMIUM 184 ) failed to meet their primary endpoints, which differed between the trials (Table 4).…”

Section: Mechanistic Implications Of Clinical Trialsmentioning

confidence: 99%

Migraine and Ischemic Stroke in Women. A Narrative Review

Tietjen

Maly

2020

Headache

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Objective/Background.-Migraine is associated with ischemic stroke. Women are 3-fold as likely as men to have migraine, and high estrogen states increase the risk of migraine with aura (MWA), venous thromboembolism (VTE), and of stroke. We review the epidemiological and mechanistic evidence of the migraine-stroke relationship and its risk factors, with a focus on women and conditions that exclusively or predominantly affect them.Methods.-We performed a search of MEDLINE/PubMed database, then a narrative review of the epidemiological evidence of the migraine-stroke relationship as well as the evidence for arterial, thrombophilic, and cardiac mechanisms to explain this connection. We examine the implications of this evidence for the diagnostic evaluation and treatment of MWA.Results.-MWA is associated with multiple stroke risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, atrial fibrillation, and patent foramen ovale. In women, MWA is also associated with biomarkers of endothelial activation, hormonal contraceptive use, pregnancy, and VTE. This suggests that a subset of auras may be secondary, that is, induced by ischemia related to microemboli or in situ thrombosis. MWA-associated ischemic stroke is more common in young (<45 years old) women with high frequency of migraine attacks, hormonal contraception use, and with pregnancy and preeclampsia. There is increasing evidence that cardioembolism, often in conjunction with thrombophilia, plays a prominent role in MWA-associated cerebral infarction.Conclusion.-The commonality of factors associated with MWA and with MWA-associated stroke suggest that persons with secondary, ischemia-induced aura may be at elevated risk of stroke. Although further research is needed, we recommend consideration of a diagnostic evaluation of MWA that mirrors the evaluation of transient ischemic attack, given that prophylactic treatment targeting the ischemic origin of secondary aura may prevent migraine as well as stroke.

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Section: Mechanistic Implications Of Clinical Trialsmentioning

confidence: 99%

Migraine and Ischemic Stroke in Women. A Narrative Review

Tietjen

Maly

2020

Headache

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“…Treatment aspects in patients with CIS and MA deserve a comment. Aspirin seems a reasonable first‐line option for antithrombotic medication in secondary prevention after CIS, as evidence from randomized controlled trials suggests aspirin can reduce the frequency of migraine attacks 41 . However, optimal dosage is unclear.…”

Section: Discussionmentioning

confidence: 99%

Association between Migraine and Cryptogenic Ischemic Stroke in Young Adults

Martinez‐Majander

Artto

Ylikotila

et al. 2020

Annals of Neurology

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Objective To assess the association between migraine and cryptogenic ischemic stroke (CIS) in young adults, with subgroup analyses stratified by sex and presence of patent foramen ovale (PFO). Methods We prospectively enrolled 347 consecutive patients aged 18 to 49 years with a recent CIS and 347 age‐ and sex‐matched (±5 years) stroke‐free controls. Any migraine and migraine with (MA) and migraine without aura (MO) were identified by a screener, which we validated against a headache neurologist. We used conditional logistic regression adjusting for age, education, hypertension, diabetes, waist‐to‐hip ratio, physical inactivity, current smoking, heavy drinking, and oral estrogen use to assess independent association between migraine and CIS. The effect of PFO on the association between migraine and CIS was analyzed with logistic regression in a subgroup investigated with transcranial Doppler bubble screen. Results The screener performance was excellent (Cohen kappa > 0.75) in patients and controls. Compared with nonmigraineurs, any migraine (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.63–3.76) and MA (OR = 3.50, 95% CI = 2.19–5.61) were associated with CIS, whereas MO was not. The association emerged in both women (OR = 2.97 for any migraine, 95% CI = 1.61–5.47; OR = 4.32 for MA, 95% CI = 2.16–8.65) and men (OR = 2.47 for any migraine, 95% CI = 1.32–4.61; OR = 3.61 for MA, 95% CI = 1.75–7.45). Specifically for MA, the association with CIS remained significant irrespective of PFO. MA prevalence increased with increasing magnitude of the right‐to‐left shunt in patients with PFO. Interpretation MA has a strong association with CIS in young patients, independent of vascular risk factors and presence of PFO. ANN NEUROL 2021;89:242–253

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“…Reviews on the relationship between migraine and CVD are scarce because of the limited number of studies available, which are mostly case‐control studies or competing studies using data from the same underlying cohort . Moreover, different methods were employed to diagnose migraine in different studies with no differentiation between aura status and striking differences in follow‐up duration .…”

Section: Clinical Considerationsmentioning

confidence: 99%

“…Moreover, different methods were employed to diagnose migraine in different studies with no differentiation between aura status and striking differences in follow‐up duration . In addition, some studies did not control important confounders or combined outcomes such as “TIA and stroke.” Hence, several meta‐analyses had moderate to high methodological heterogeneity, and the inferences were restricted because of the limitations of the studies included …”

Section: Clinical Considerationsmentioning

confidence: 99%

“…Additionally, some drugs possibly have preventive effects on migraine and could also reduce cardiovascular risk, such as propranolol; 56 drugs acting on the renin-angiotensin system, 33 such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers; 57 statins; [58][59][60] and aspirin. [61][62][63] Overall, strong evidence demonstrates that migraine is an important and possibly independent risk factor for cerebrovascular disease. It is also reasonable to instruct migraine patients to avoid other conventional vascular risk factors, such as stress, sleep disturbance, sedentary lifestyle, and obesity, among others possibly related to oxidative stress and also implicated in migraine pathophysiology.…”

Section: Clinical Considerationsmentioning

confidence: 99%

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Migraine and cerebrovascular diseases: Epidemiology, pathophysiological, and clinical considerations

Magalhães

Rocha-Filho

2018

Headache

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Migraine and cerebrovascular diseases are disabling disorders, which are possibly closely interrelated. Heterogeneous and scattered evidence in literature remains a challenge. We searched for systematic reviews including diverse cerebrovascular events in migraineurs and reported relevant original studies to update the evidence when necessary. The studies show that migraine is associated with increased risk of transient ischemic attacks, any stroke, and possibly hemorrhagic stroke. In addition, migraine with aura increases the risk of ischemic stroke and white matter abnormalities. Migraine without aura increases the risk of cervical artery dissection as a cause of ischemic stroke. Groups with specific risk profiles are women, young people, smokers, and oral contraceptive users. The pathophysiology of the association remains uncertain. However, genetic and environmental factors may be involved in intricate mechanisms responsible for oxidative stress, vascular dysfunction and, ultimately, vascular events. In conclusion, migraine is a potential risk factor for cerebrovascular diseases. Migraineurs should be carefully evaluated considering their vascular risk assessment based on current evidence, so that healthcare professionals can provide appropriate and individualized management of other cardiovascular risk factors, notably quitting smoking and restricting use of oral contraceptives.

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The effectiveness of aspirin for migraine prophylaxis: a systematic review

Cited by 16 publications

References 33 publications

Migraine and Ischemic Stroke in Women. A Narrative Review

Migraine and Ischemic Stroke in Women. A Narrative Review

Association between Migraine and Cryptogenic Ischemic Stroke in Young Adults

Migraine and cerebrovascular diseases: Epidemiology, pathophysiological, and clinical considerations

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