Migraine Age of Onset and Association With Ischemic Stroke in Late Life: 20 Years Follow‐Up in ARIC

Abstract

Background and Purpose To evaluate the association between cumulative exposure to migraine and incidence of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study. Methods In this ongoing, prospective longitudinal community‐based cohort, participants were interviewed to ascertain migraine history at the third visit (1993–1995), followed for ischemic stroke incidence over 20 years. We performed a post hoc analysis to evaluate the association between the age of migraine onset and ischemic stroke. Results We identified 447 migraineurs with aura (MA) and 1128 migraineurs without aura (MO) among 11,592 black and white participants. There was an association between the age of MA onset ≥50 years old (average duration = 4.75 years) and ischemic stroke when compared to no headache group (multivariable adjusted HR = 2.17, 95% CI [1.39–3.39], P < .001). MA onset <50 years old (average duration = 28.17 years) was not associated with stroke (multivariable adjusted HR = 1.31, 95% CI [0.86–2.02], P = .212). These results were consistent with our logistic regression model. MO was not associated with increased stroke regardless of the age of onset. The absolute risk for stroke in migraine with aura is 37/447 (8.27%) and migraine without aura is 48/1128 (4.25%). Conclusion As compared to the no headache participants, increased stroke risk in late life was observed in participants with late onset of MA. In this cohort, longer cumulative exposure to migraine with visual aura, as would be expected with early onset of migraine, was not associated with increased risk of ischemic stroke in late life. This study underscores the importance of the age of onset of MA in assessing stroke risk in older migraineurs.

Migraine and Ischemic Stroke in Women. A Narrative Review

“…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 . These findings, combined with the discovery that late‐life ischemic stroke was associated with late (rather than early) onset MWA, 156 implies that aura may be secondary to atrial fibrillation‐associated microembolism. Supporting this hypothesis, the Danish population‐based cohort study reported that the risk of atrial fibrillation and atrial flutter were increased in persons with migraine, but only women (1.34; 95% CI: 1.22‐1.48) and those with MWA (1.31; 95% CI: 1.11‐1.55) 36 …”

History of Migraine and Volume of Brain Infarcts: The Italian Project on Stroke at Young Age (IPSYS)

“…Such a risk was also around 3-fold higher among women younger than 45 years [2,20], 9-fold higher among current smokers [2], and 7-fold higher among women taking oral contraceptives [2,20]. More recently, data from Atherosclerosis Risk in Communities (ARIC) study suggested increased incidence of atrial fibrillation and cardioembolic stroke in older migraineurs with visual aura [22], especially among subjects with late onset migraine with aura [23]. Taken together, despite some conflicting evidence [24-26], these findings and our own results support the prevailing idea that migraine is a highly prevalent and perhaps modifiable predisposing factor for brain ischemia, though the exact mechanisms underlying this relationship remain to be clarified.…”

Triptans for Migraine Patients With Vascular Risks: New Insights, New Options

“…56 Interestingly, MWA has been associated with atrial fibrillation and patent foramen ovale (PFO) -2 conditions associated with emboli. In a study examining the risk associated with migraine for different subtypes of strokes, an increased hazard for cardioembolic stroke was found, but the hazard ratio for lacunar and non-lacunar/non-cardioembolic stroke was not significant.…”

“…In a study examining the risk associated with migraine for different subtypes of strokes, an increased hazard for cardioembolic stroke was found, but the hazard ratio for lacunar and non-lacunar/non-cardioembolic stroke was not significant. 56 Interestingly, MWA has been associated with atrial fibrillation and patent foramen ovale (PFO) -2 conditions associated with emboli. 57,58 In the case of our patient, the etiology of the stroke was a cervical artery dissection, a stroke subtype also associated with migraine, with a recurrence rate between 5 and 10%.…”