Migraine and stroke: In search of shared mechanisms

Mawet, Jérôme; Kurth, Tobias; Ayata, Cenk

doi:10.1177/0333102414550106

Cited by 72 publications

(76 citation statements)

References 180 publications

(219 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…22 Cortical spreading depression, the physiologic correlate of migraine with aura, has also been suggested as an underlying link between migraine with aura and ischemic stroke. 23 Moreover, both animal models of familial hemiplegic migraine (FHM type 1 mutant mice), and inherited monogenic vasculopathies such as CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), for which migraine with aura is a feature, support the hypothesis that transient hypoperfusion or ischemic depolarization is associated with increased stroke susceptibility and migraine. 24 Molecular genetics has revealed associations between migraine and genetic polymorphisms of angiotensin I-converting and enzyme, 5, 10 methylenetetrahydrofolate (MTHFR), suggesting the potential of shared genetic risks for stroke.…”

Section: Resultsmentioning

confidence: 93%

Migraine and risk of stroke in older adults

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 93%

Migraine and risk of stroke in older adults

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Speculated mechanisms consist mainly of vasospasm [19, 20], prolonged of cortical spreading depression [21], platelet hyperaggregability [22, 23], increased prothrombotic factors [24, 25], endothelial abnormalities [26, 27] and alteration of arterial function [28]. In addition, a recent systemic review and meta-analysis study [29] has reported an association between migraine with myocardial infarction, The study suggests that the association is more obvious and evident in women, which was in line with results of the present study.…”

Section: Discussionmentioning

confidence: 99%

The potential impact of primary headache disorders on stroke risk

et al. 2016

View full text Add to dashboard Cite

BackgroundHeadache such as migraine is associated with stroke. Studies focused on primary headache disorders (PHDs) as a risk factor for stroke are limited. The purpose of this population-based cohort study was to explore whether patients with PHDs were at a high risk for developing stroke.MethodsA total of 1346 patients with PHDs were enrolled and compared with 5384 age-, gender- and co-morbidity-matched control cohorts. International Classification of Diseases, Clinical Modification codes were administered for the definition of PHDs, stroke, and stroke risk factors. Cox proportional-hazards regressions were performed for investigating hazard ratios (HR).ResultsPHDs patients exhibited a 1.49 times (95% CI :1.15–1.98, p < 0.01) higher risk for developing ischaemic stroke compared with that of control cohorts. Both migraine (HR = 1.22, 95% CI :1.13–1.97, p < 0.05) and tension-type headache (HR = 2.29, 95% CI :1.22–2.80, p < 0.01) were associated with an increased risk of ischemic stroke. Females with PHDs were at greater risk of developing ischaemic stroke (HR = 1.49, 95% CI :1.13–1.90, p < 0.01) than those without PHDs. PHDs patient aged 45 to 64 years displayed significantly higher risk to develop ischaemic stroke (HR = 1.50, 95% CI: 1.11–2.10, p < 0.05) than the matched controls. The impact of PHDs on ischaemic stroke risk became gradually apparent by different following time intervals beyond 2 years after first diagnosis.ConclusionPHDs is suggestive of an incremental risk for ischaemic stroke with gender-dependent, age-specific and time-dependent characteristics.Electronic supplementary materialThe online version of this article (doi:10.1186/s10194-016-0701-2) contains supplementary material, which is available to authorized users.

show abstract

“…These 2 diseases, one seemingly benign and the second often severe and catastrophic, remain common neurologic disorders with a high socioeconomic burden [2•]. Stroke is the second most common cause of death worldwide and the third most common cause of disability [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Migraine and Stroke: What’s the Link? What to Do?

Gryglas

Śmigiel

2017

Curr Neurol Neurosci Rep

View full text Add to dashboard Cite

Migraine and stroke are common, disabling neurologic disorders, with a high socioeconomic burden. A link between them has been proposed years ago, and various theories have been proposed to explain this bidirectional relation. However, the precise causes remain unclear. We briefly summarize existing hypotheses of this correlation seeking for recommendations for stroke prevention in migraineurs, if any exist. Among the strongest suggested theories of migraine–stroke association are cortical spreading depression, endovascular dysfunction, vasoconstriction, neurogenic inflammation, hypercoagulability, increased prevalence of vascular risk factors, shared genetic defects, cervical artery dissection, and patent foramen ovale. There is no evidence that any preventive therapy in migraineurs should be used to decrease stroke risk, even in most predisposed subset of patients. However, a woman with migraine with aura should be encouraged to cease smoking and avoid taking oral contraceptives with high estrogen doses. We need further investigation to better understand the complexity of migraine–stroke association and to make firm recommendations for the future.

show abstract

Migraine and stroke: In search of shared mechanisms

Cited by 72 publications

References 180 publications

Migraine and risk of stroke in older adults

Migraine and risk of stroke in older adults

The potential impact of primary headache disorders on stroke risk

Migraine and Stroke: What’s the Link? What to Do?

Contact Info

Product

Resources

About