Atrial fibrillation and migraine with aura in young adults with ischemic stroke

Abstract

Background Migraine is associated with an increased risk of ischemic stroke. The associations are stronger in migraine with aura than in migraine without aura, in women than in men, and in younger subjects. However, the mechanisms by which migraine might increase the risk of ischemic stroke are debated. Methods We analysed the associations between migraine without aura and migraine with aura and the causes of ischemic stroke in patients aged 18–54 years treated consecutively in a university hospital stroke center. Results A total of 339 patients (mean/SD age 43.8/8.8 years, 62.83% male) were included. Migraine with aura was diagnosed in 58 patients, and migraine without aura in 54 patients. Patients with migraine with aura were younger and had fewer traditional cardiovascular risk factors than patients with no migraine. Migraine with aura was strongly associated with atrial fibrillation (odds ratio, 5.08; 95% confidence interval, 1.24–21.92; p = 0.011) and negatively associated with atherosclerosis (odds ratio, 0.29; 95% confidence interval, 0.05–0.97; p = 0.033) and small vessel disease (odds ratio, 0.13; 95% confidence interval, 0.00–0.87; p = 0.022). No other cause of stroke was significantly associated with migraine. The most common cause of stroke was atherosclerosis in no-migraine patients, dissection in migraine without aura patients and patent foramen ovale in migraine with aura patients. Atrial fibrillation was, together with dissection, the second leading cause of stroke in migraine with aura patients, accounting for 10.34% of cases in this subgroup. Conclusion We showed that atrial fibrillation was a common cause of ischemic stroke in young adults with migraine with aura.

Cardiac sources of cerebral embolism in people with migraine

“…These figures are much lower than the prevalence of migraine and MA reported in similar European studies of stroke patients. Thus, in the Oxford cohort study, the prevalence of migraine among patients with ischaemic stroke/transient ischaemic attack (mean age, 73.4 years) was 21.9%, and the prevalence of MA was 14.5% [5] In the above-mentioned French study in young adults with ischaemic stroke (mean age, 43.8 years), the prevalence of migraine was 33.0% and the prevalence of MA 17.1% [4] The prevalence of migraine in the study by De Giuli et al was also lower than the 15% prevalence of migraine usually reported in population-based studies.…”

“…We read with interest the original article by De Giuli et al on the cardiac sources of embolism associated with a history of migraine in stroke patients [1] Although patent foramen ovale was significantly more frequent in patients with migraine with aura (MA), no association was detected between atrial fibrillation (AF) and any type of was 14.5% [5] In the above-mentioned French study in young adults with ischaemic stroke (mean age, 43.8 years), the prevalence of migraine was 33.0% and the prevalence of MA 17.1% [4] The prevalence of migraine in the study by De Giuli et al was also lower than the 15% prevalence of migraine usually reported in population-based studies.…”

“…In a Danish, nationwide, population-based cohort study, MA was associated with incident AF (hazard ratio [HR]: 1.31, 95% confidence interval [CI]: 1.11-1.55) [2] In a large community-based cohort study of American adults, MA was associated with incident AF (HR: 1.30, 95% CI: 1.03-1.62) and increased risk of cardioembolic stroke. A mediation analysis suggested that this risk was explained by AF [3] In a French series of young adults consecutively treated in the hospital for acute ischaemic stroke, MA was strongly associated with AF (odds ratio: 5.08, 95% CI: 1.24-21.92) [4] The study by De Giuli et al included 1738 patients (mean age, 67.9 years), of whom 157 patients were diagnosed with migraine (45 with MA), resulting in a prevalence of migraine of 9.0% and a prevalence of MA of 2.6%. These figures are much lower than the prevalence of migraine and MA reported in similar European studies of stroke patients.…”

Migraine and large artery atherosclerosis in young adults with ischemic stroke

“…However, the increased risk of ischemic stroke in people experiencing migraine may also be accounted for by the association of migraine with cardiovascular conditions that can lead to stroke. Indeed, studies in young adults with ischemic stroke have shown associations of MWoA with dissection 4,5 ; MWA with patent foramen ovale (PFO), 6–8 especially PFO combined with atrial septal aneurysm 9 ; and MWA with atrial fibrillation 10 …”

“…The association between migraine and large artery atherosclerosis (LAA) in patients with ischemic stroke has been investigated in a few studies that, in our opinion, do not allow a definite conclusion to be drawn 7,10–13 . Indeed, one of these studies included only women 11 ; two studies included elderly people, in whom the high prevalence of LAA may have masked any association between migraine and LAA 12,13 ; and in the other two studies, the association between migraine and LAA was not adjusted for traditional vascular risk factors 7,10 . Furthermore, in all but one study, LAA was diagnosed in patients with >50% arterial stenosis.…”