Migraine and risk of stroke in older adults

Abstract

Objective: To examine the association between migraine and stroke/vascular outcomes in a racially/ethnically diverse, older cohort.Methods: Participants from the Northern Manhattan Study, a population-based cohort study of stroke incidence, were assessed for migraine symptoms using a self-report questionnaire based on criteria from the International Classification of Headache Disorders, second edition. We estimated the association between migraine and combined vascular events including stroke and stroke only over a mean follow-up of 11 years, using Cox models adjusted for sociodemographic and vascular risk factors.Results: Of 1,292 participants (mean age 68 6 9 years) with migraine data followed prospectively for vascular events, 262 patients (20%) had migraine and 75 (6%) had migraine with aura. No association was found between migraine (with or without aura) and risk of either stroke or combined cardiovascular events. There was an interaction between migraine and current smoking (p 5 0.02 in relation to stroke and p 5 0.03 for combined vascular events), such that those with migraine and smoking were at an increased risk. The hazard ratio of stroke for migraine among current smokers was 3.17 (95% confidence interval [CI] 1.13-8.85) and among current nonsmokers was 0.77 (95% CI 0.44-1.35). In relation to combined vascular events, the hazard ratio for migraine vs no migraine among current smokers was 1.83 (95% CI 0.89-3.75) and among current nonsmokers was 0.63 (95% CI 0.43-0.94). Conclusion:In our racially/ethnically diverse population-based cohort, migraine was associated with an increased risk of stroke among active smokers but not among nonsmokers. Migraine is a complex neurovascular syndrome resulting in an unstable trigeminal vascular system. It has been suggested that migraine and stroke exist on a continuum, and the vascular system may have important secondary consequences in migraine.1 While the vascular theory of migraine has been disproved, migraine with aura, mostly in women younger than 45 years, has been shown to be an independent risk factor for ischemic stroke.2 Some studies also suggest that migraine is associated with an unfavorable cardiovascular risk profile, cardiovascular disease events, and vascular death.3-8 However, there are no reliable indicators to predict which migraineurs will develop cerebrovascular ischemic insults and other vascular events. Moreover, migraine may be a potentially modifiable vascular risk factor, requiring further exploration in high-risk populations.The objective of this study was to assess the association between migraine, including both migraine with and without aura, and stroke in the Northern Manhattan Study (NOMAS), an ethnically diverse, older, community-based cohort. As a secondary aim, we also explored the association between migraine and vascular events/mortality.

Are migraine and non‐migrainous headache risk factors for stroke in the elderly? Findings from a 12‐year cohort follow‐up

“…It is in keeping with the low risk of haemorrhagic stroke found amongst middle‐aged women (mean 54.9) with migraine . As in a recent study , no overall association between migraine and stroke was found. However, the evidence for a link between the two is often limited to migraine with aura and female gender and younger age groups , and the risk is greatly increased when migraine is combined with smoking, oral contraceptive use and high blood pressure .…”

The potential impact of primary headache disorders on stroke risk

“…Accumulating evidence has highlighted the association of ischaemic stroke with previous migraine [8, 14–16]. A meta-analysis reviewing 13 case–control, 10 cohort, and two cross sectional studies has suggested that migraine is one of independent risk factors for ischaemic stroke [14].…”

Hypertension and Migraine in the Northern Manhattan Study

“…23,24 In a prior NOMAS study assessing migraine as a risk factor for stroke, no interaction between migraine and hypertension was found; this may have been due to a low power to detect a difference. 25 In another study, the presence of hypertension and migraine was found to increase the risk of stroke/ TIA in the low Framingham risk score group. 8 Ethnic differences in carotid artery diameter and stiffness were observed in Hispanics but not Blacks or among Whites; and, there is some evidence that migraine may be associated with enhanced arterial stiffness.…”