Migraine and atrial fibrillation: a systematic review

Scutelnic, Adrian; Mattle, Heinrich; Branca, Mattia; Jung, Simon; Reichlin, Tobias; Fischer, Urs; Schankin, Christoph

doi:10.1111/ene.15198

Cited by 15 publications

(11 citation statements)

References 51 publications

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“…MwA doubles the risk of stroke, and especially in the young there is a strong association between MwA and stroke even in the absence of vascular risk factors ( 12 , 13 ). Whether the doubling of stroke risk is due to primary MwA or due to a disorder causing secondary MwA and stroke is unknown ( 12 , 14 , 15 ). In addition, there is an association of MwA and patent foramen ovale (PFO), and in patients with cryptogenic stroke who have migraine, there is a high prevalence of PFO (79%) with right-to-left shunt ( 12 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

Migraine aura-like symptoms at onset of stroke and stroke-like symptoms in migraine with aura

et al. 2022

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Background and objectivesIn general, suddenly occurring neurological deficits, i.e., negative neurological symptoms, are considered symptoms of focal cerebral ischemia, while positive irritative symptoms with gradual onset are viewed as the characteristics of migraine aura. Nevertheless, cortical spreading depolarization, the pathophysiological basis of migraine aura, has also been observed in acute ischemic stroke. The aim of our study was to determine the frequency of migraine aura-like symptoms at ischemic stroke onset and stroke-like symptoms in migraine with aura.MethodsWe interviewed 350 consecutive patients with ischemic stroke and 343 with migraine with aura using a structured questionnaire. Stroke diagnosis was confirmed by imaging, and migraine with aura was diagnosed according to the current criteria of the International Headache Society. Patients with wake-up strokes or severe cognitive deficits that precluded a useful interview were excluded from the study.ResultsSeventy-eight patients with stroke (22.3%) reported visual symptoms, 145 (41.4%) sensory symptoms, 197 (56.3%) a paresis, and 201 patients (57.4%) more than one symptom, compared to 326 migraine patients with aura (95%) with visual symptoms (P < 0.001), 175 (51%) with sensory symptoms (p = 0.011), 50 (14.6%) with paresis (P < 0.001), and 211 (61.5%) with more than one symptom (p = 0.27). Among patients with stroke, migraine-like symptoms were frequent: 36 patients (46.2%) with visual disturbance and 78 (53.8%) with sensory symptoms experienced irritative sensations. Paresis-onset in stroke lasted longer than 5 min in 43 patients (21.8%). Spreading of sensory and motor symptoms occurred in 37 (25.5%) and 37 (18.8%) patients, respectively. Stroke-like negative symptoms in migraine with aura occurred in 39 patients (12%) with visual symptoms, in 55 (31.4%) with sensory symptoms, and paresis appeared suddenly in 14 patients (28%). More than one symptom in succession occurred in 117 migraine patients with stroke (58.2%) and in 201 migraine patients with aura (95.3%; P < 0.001).ConclusionMany patients with stroke experience migraine-like symptoms at stroke onset, and many migraines with aura patients have stroke-like symptoms. Though overall the symptom frequencies of the two groups are significantly different, clarifying the differential diagnosis in an individual patient requires additional history elements, physical findings, or results of ancillary investigations.

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Section: Discussionmentioning

confidence: 99%

Migraine aura-like symptoms at onset of stroke and stroke-like symptoms in migraine with aura

et al. 2022

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“…Available evidence suggests 2fold increased risk of stroke among patients with migraine [7,8], and recurrence of stroke in young populations [9]. Studies including a recent meta-analysis demonstrated greater risk particularly in individuals aged less than 45 years, women with migraine with aura (MA), oral contraceptive users, and smokers [8, 10,11]. A recent follow-up study from South Korea that included individuals aged > 40 years also showed 35% greater risk among migraineurs [12].…”

Section: Introductionmentioning

confidence: 99%

Risk of stroke in patients with migraine. A register-linked HUNT study

Giri,

Tronvik,

Dalen

et al. 2024

Preprint

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Background The association between migraine and stroke remains unclear. The aim of this large population-based 15-year follow-up study was to investigate whether primary headache disorders, including subtypes of migraine, increase the risk of stroke. Methods This population-based 15-year follow-up study used baseline headache data from the third Trøndelag Health Study (HUNT3) performed between 2006 and 2008. The HUNT3 headache data were linked to the Norwegian National Stroke Register that includes stroke diagnoses recorded from 2012 until December 2021. The association between stroke and headache status was investigated in individuals aged ≥ 20 years without stroke at baseline. Prospective associations were evaluated using multivariable Cox proportional hazard models with 95% confidence intervals (CIs). Separate sub-group analyses by age and sex were performed. Results Among 37,364 included participants, 1,095 (2.9%) developed stroke, whereof 13.4% were younger than 55 years. In the multi-adjusted model, reporting migraine with aura (MA) at baseline was associated with increased risk of stroke at follow-up (HR 1.55, 95% CI 1.16–2.08) compared with those without headache. The increased risk of stroke was most evident among individuals with MA who were less than 55 years old (HR 1.98, 95% CI 1.20–3.27) and among women (HR 1.64, 95% CI 1.12–2.41). Conclusions During 15 years of follow-up, individuals with MA were more likely to suffer from stroke compared to those without headache. The relationship with MA was even stronger in women, and for young individuals aged < 55 years.

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“…4 Third, the complex association between atrial fibrillation and migraine has been a little oversimplified not covering issues, such as hypercoagulability, antithrombotics as migraine prevention therapy, and others. 5…”

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“…4 Finally, we recognize that the relationship between atrial fibrillation and migraine with aura is complex and can be either direct or indirect. 5 However, our review focused on microembolism and its role in migraine and stroke pathophysiology. Other associations between cardiac arrhythmias and stroke risk in patients with migraine were beyond this Review's scope.…”

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Reader Response: Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update

Scutelnic¹,

Jung²,

Schankin³

2023

Neurology

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We read with great interest the review by Sacco et al.1 and generally agree with their findings. However, we would like to outline some limitations. First, the clinical description of symptoms of stroke compared with the habitual migraine aura is limited to 2 small series: Olesen et al.2 reported 5 patients with previous MA and ischemic stroke, and Wolf et al.3 took the symptoms of 11 patients solely from the charts. Therefore, we believe that more emphasis should be put on the lack of data on clinical features of stroke in patients with known migraine with aura.

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Migraine and atrial fibrillation: a systematic review

Cited by 15 publications

References 51 publications

Migraine aura-like symptoms at onset of stroke and stroke-like symptoms in migraine with aura

Migraine aura-like symptoms at onset of stroke and stroke-like symptoms in migraine with aura

Risk of stroke in patients with migraine. A register-linked HUNT study

Reader Response: Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update

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