Association between Migraine and Cryptogenic Ischemic Stroke in Young Adults

Martinez‐Majander, Nicolas; Artto, Ville; Ylikotila, Pauli; Sarnowski, Bettina von; Waje‐Andreassen, Ulrike; Yeşilot, Nilüfer; Zedde, Marialuisa; Huhtakangas, Juha; Numminen, Heikki; Jäkälä, Pekka; Fonseca, Ana; Redfors, Petra; Wermer, Marieke J.H.; Pezzini, Alessandro; Putaala, Jukka

doi:10.1002/ana.25937

Cited by 32 publications

(32 citation statements)

References 44 publications

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“…3.6 in men in the most recent study published in 2020). 26 There may also be an increased risk for hemorrhagic stroke in patients with migraine, however. A large study published in 2013 27 found an increased risk (adjusted H.R.…”

Section: Discussionmentioning

confidence: 99%

A trial of antithrombotic therapy in patients with refractory migraine and antiphospholipid antibodies: A retrospective study of 75 patients

Schofield

Hughes

Birlea³

et al. 2021

Lupus

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Objective It has been reported that patients with antiphospholipid antibodies (aPL) and refractory migraine may experience symptomatic improvement with antithrombotic therapy, but this phenomenon has not been well studied. This study was undertaken to detail the response to trials of antithrombotic therapy in these patients. Methods This is a retrospective study of 75 patients with refractory migraine and aPL who were given a 2–4 week trial of aspirin, clopidogrel and/or anticoagulation. Major response was defined as 50–100% improvement in frequency and/or severity of migraine; minor response: 25–49% improvement; no response: <25% improvement. Results 66 patients were given a trial of aspirin: 47% responded (21% major); 60 patients were given a trial of clopidogrel: 83% responded (67% major); and 34 patients were given a trial of anticoagulation (usually apixaban): 94% responded (85% major). The response rate to any anti-thrombotic therapy was 89% (83% major). Many patients also noted improvement in non-headache symptoms. No patient experienced stroke. There was no major bleeding during any 2–4 week treatment trial and only 3 of 69 patients maintained on an antithrombotic regimen for a median follow up of 29.9 months (5–100) experienced major bleeding. Conclusions There was a high rate of symptomatic response to antithrombotic therapy in this context and long-term follow up suggested an individualized symptom-derived antithrombotic regimen may be associated with a low bleeding risk. Our data support consideration of a 2–4 week trial of antithrombotic therapy, usually starting with antiplatelet therapy, in aPL-positive patients with refractory migraine, particularly if other treatment options have been exhausted. As a retrospective study, our data provide only Class IV level of evidence, but they suggest randomized controlled trials are warranted to validate these encouraging findings.

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Section: Discussionmentioning

confidence: 99%

A trial of antithrombotic therapy in patients with refractory migraine and antiphospholipid antibodies: A retrospective study of 75 patients

Schofield

Hughes

Birlea³

et al. 2021

Lupus

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“…Previous studies on stroke etiology reported lower frequencies of large vessel and cardio-embolic stroke etiology in female migraine patients and more infarcts of unknown origin in migraine patients in general ( Rist et al, 2010 ; Li et al, 2015 ). In a recent study, migraine with aura was strongly associated with cryptogenic stroke, whereas such association was not found in migraine without aura ( Martinez-Majander et al, 2021 ). The association of migraine with aura with stroke was independent of vascular risk factors or patent foramen ovale.…”

Section: Discussionmentioning

confidence: 95%

Sex Differences in Risk Profile, Stroke Cause and Outcome in Ischemic Stroke Patients With and Without Migraine

Linstra

Ruigrok

et al. 2021

Front. Neurosci.

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Background: An increased risk of stroke in patients with migraine has been primarily found for women. The sex-dependent mechanisms underlying the migraine–stroke association, however, remain unknown. This study aims to explore these sex differences to improve our understanding of pathophysiological mechanisms behind the migraine–stroke association.Methods: We included 2,492 patients with ischemic stroke from the prospective multicenter Dutch Parelsnoer Institute Initiative study, 425 (17%) of whom had a history of migraine. Cardiovascular risk profile, stroke cause (TOAST classification), and outcome [modified Rankin scale (mRS) at 3 months] were compared with both sexes between patients with and without migraine.Results: A history of migraine was not associated with sex differences in the prevalence of conventional cardiovascular risk factors. Women with migraine had an increased risk of stroke at young age (onset < 50 years) compared with women without migraine (RR: 1.7; 95% CI: 1.3–2.3). Men with migraine tended to have more often stroke in the TOAST category other determined etiology (RR: 1.7; 95% CI: 1.0–2.7) in comparison with men without migraine, whereas this increase was not found in women with migraine. Stroke outcome was similar for women with or without migraine (mRS ≥ 3 RR 1.1; 95% CI 0.7–1.5), whereas men seemed to have a higher risk of poor outcome compared with their counterparts without migraine (mRS ≥ 3 RR: 1.5; 95% CI: 1.0–2.1).Conclusion: Our results indicate possible sex differences in the pathophysiology underlying the migraine–stroke association, which are unrelated to conventional cardiovascular risk factors. Further research in larger cohorts is needed to validate these findings.

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“…The study design was described in detail previously. 18,19 Participants for the present analysis were enrolled between October 2013 and April 2020. Written informed consent was obtained from all participants, and the study was approved by the ethics committees of the participating hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…Based on medical records and structured interviews, we identified relevant comorbidities, such as diabetes mellitus (i.e., prior diabetes diagnosis and/or prior antidiabetic medication), hypertension (i.e., prior hypertension diagnosis, prior antihypertensive medication, or the mean of two office blood pressure measures >140/90 mmHg at study visit), history of cardiovascular disease (coronary heart disease, congestive heart failure, peripheral arterial disease, or atrial fibrillation), and migraine with aura (MA), assessed with a validated migraine screening protocol. 19 Information on lifestyle factors was based on structured interviews conducted during study visits. Cigarette smoking was classified as smoking at least one cigarette during the year prior to the index stroke.…”

Section: Comorbiditiesmentioning

confidence: 99%