Ischemic stroke subtypes and migraine with visual aura in the ARIC study

Abstract

Objective: To investigate the association among migraine, ischemic stroke, and stroke subtypes in the Atherosclerosis Risk in Communities (ARIC) study.Methods: In this ongoing, prospective, longitudinal community-based cohort study, participants were given an interview ascertaining migraine history in 1993-1995, and were followed for all vascular events, including stroke. All stroke events over the subsequent 20 years were adjudicated and classified into stroke subtypes by standard definitions. Cox proportional hazards models adjusted for stroke risk factors were used to study the relationship between migraine and ischemic stroke, overall, as well as stroke subtypes (cardioembolic, lacunar, or thrombotic).Results: We identified 1,622 migraineurs among 12,758 participants. Mean age of the study population at the 3rd clinical visit was 59 years. When compared to nonheadache participants, there was a significant association between migraine with visual aura and ischemic stroke (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.2-2.6, p 5 0.008). Migraine without visual aura was not significantly associated with ischemic stroke (HR 1.2, CI 1.0-1.8, p 5 0.28) when compared to nonheadache participants. Among the 3 subtypes of ischemic stroke evaluated, migraine with visual aura was significantly associated only with cardioembolic stroke (HR 3.7, 95% CI 1.6-8.7, p 5 0.003). Conclusion:In participants with migraine with visual aura in late middle age, increased risk of cardioembolic stroke was observed. Migraine with visual aura was linked to increased stroke risk, while migraine without visual aura was not, over the period of 20 years. These results are specific to older migraineurs. Neurology ® 2016;87:2527-2532 GLOSSARY ARIC 5 Atherosclerosis Risk in Communities; BMI 5 body mass index; CGRP 5 calcitonin gene-related peptide; CI 5 confidence interval; HR 5 hazard ratio; ICHD 5 International Classification of Headache Disorders; LDL 5 low-density lipoprotein; NSAID 5 nonsteroidal anti-inflammatory drugs; PFO 5 patent foramen ovale; WHS 5 Women's Health Study.

Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

“…Several case-control and cohort studies, as well as pooled data analyses, indicate that migraine is a risk factor for stroke and other vascular events [ 1 – 6 ]. Most of the evidence supports an increased risk of ischemic stroke associated with migraine with aura [ 7 – 18 ]. For migraine without aura, the interpretation of available data is more complex as some studies reported that migraine without aura is also associated with an increased risk of ischemic stroke [ 10 , 18 , 19 ] whereas in others the association was not confirmed [ 7 , 11 , 15 , 16 ].…”

Migraine and Ischemic Stroke in Women. A Narrative Review

“…In the ARIC study, migraine with visual aura was associated with cardioembolic stroke (HR 1.7; 95% CI: 1.2‐2.6, P = .008), but not with thrombotic or lacunar subtypes, suggesting visual aura symptoms may be related to distal emboli in the posterior circulation 154 . The study also reported that MWA was associated with increased risk of new onset atrial fibrillation, an important stroke risk factor in the aged 155 .…”

Migraine with Aura as a Stroke Mimic

“…4 The increased incidence of atrial fibrillation and cardioembolism in patients diagnosed with migraine with aura was linked to acute stroke. 5,6 Migraine with aura can also be found as a stroke mimic during acute stroke management 7 ; however, only a few studies investigated the frequency and characteristics of migraine with aura in patients who initially presented with strokelike symptoms.…”

“…4 Recent studies showed that migraine with aurainduced stroke may be associated with an increased risk of incidental atrial fibrillation and cardioembolic stroke. 5,6 Because we included patients diagnosed with migraine with aura who initially presented with stroke-like symptoms, all patients underwent ECG and multimodal CT scan, and more than half patients underwent DWI MRI. We found no patients with perfusion change or asymptomatic ischemic stroke.…”