Predictors of Migraine Subtypes in Young Adults With Ischemic Stroke

Pezzini, Alessandro; Grassi, Mario; Lodigiani, Corrado; Patella, Rosalba; Gandolfo, Carlo; Casoni, Federica; Musolino, Rossella; Calabrò, Rocco Salvatore; Bovi, Paolo; Adami, Alessandro; DeLodovici, Maria Luisa; Zotto, Elisabetta Del; Rota, L.; Rasura, Maurizia; Sette, Massimo Del; Giossi, Alessia; Volonghi, Irene; Zini, Andrea; Cerrato, Paolo; Costa, Paolo; Magoni, Mauro; Iacoviello, Licia; Padovani, Alessandro

doi:10.1161/strokeaha.110.592246

Cited by 60 publications

(67 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In conclusions, in young age the prevalence of common vascular RF is lower and MA appears directly associated with IS, while in older migraineurs they seem to increase IS risk [30,31]. Among genetic RF, the MTHFR 677C [ T or the ACE D/I polymorphisms seem to increase IS risk in people with MA [32].…”

Section: Pathophysiological Hypothesesmentioning

confidence: 85%

Migraine with aura: which patients are most at risk of stroke?

Falco

2015

Neurol Sci

View full text Add to dashboard Cite

The complex association between migraine (M) and ischemic stroke (IS) is discussed. Epidemiological studies and meta-analyses show that M with aura (MA) and not M without aura, doubles the risk of IS. The risk is higher for female gender, young age and higher headache attacks frequency. Smoking habit and oral contraceptives, especially if associated, increase stroke risk. The underlying pathogenetic mechanisms are not completely understood, but it is hypothesized that a particular brain susceptibility to cortical spread depression could explain the association between MA and IS. The absolute risk of IS in migraineurs is relatively low and an antithrombotic primary prevention is not indicated, but it is mandatory to investigate and treat associated risk factors for IS and, in young MA women, consider only progestinic oral contraceptives, if needed, and smoking cessation.

show abstract

Section: Pathophysiological Hypothesesmentioning

confidence: 85%

Migraine with aura: which patients are most at risk of stroke?

Falco

2015

Neurol Sci

View full text Add to dashboard Cite

show abstract

“…4 Centers are included in the network provided that the recruitment process of stroke cases takes place prospectively. The study was approved by the local Ethics Committee.…”

Section: Patients and Study Designmentioning

confidence: 99%

Predictors of Long-Term Recurrent Vascular Events After Ischemic Stroke at Young Age

et al. 2014

Self Cite

View full text Add to dashboard Cite

Background-Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited. Methods and Results-We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%-17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%-17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%-1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphospholipid antibodies, discontinuation of antiplatelet and antihypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of the composite end point in multivariable Cox proportional hazards analysis. A point-scoring system for each variable was generated by their β-coefficients, and a predictive score (IPSYS score) was calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve of the 0-to 5-year score was 0.66 (95% confidence interval, 0.61-0.71; mean, 10-fold internally cross-validated area under the receiver operating characteristic curve, 0.65).© 2014 American Heart Association, Inc. 1 Although it is well documented that such a risk is much lower in young patients with stroke than in elderly patients, information on what specific factors may predict recurrent events in younger age groups are limited. Most data derive from single-center studies enrolling several hundred patients or less, 2 using different thresholds of age to define young, and sometimes being biased by the inadequate capture of cases, the inclusion of different ethnic groups, and the high number of patients lost to follow-up.3 This makes such studies somewhat heterogeneous and their findings poorly comparable. In addition, the influential effect of some specific factors is missing in most previous studies. This is the case, for example, of patients' adherence to secondary prevention therapies, which is likely to impact the recurrence of potentially avoidable vascular events. The Italian Project on Stroke in Young Adults (IPSYS) provides the opportunity to investigate these issues owing to its large sample size, the homogeneous demographic characteristics and clinical phenotype of the subjects included, and the standard diagnostic workup. Therefore, in the present study we aimed at (1) elucidating the predictors of long-term recurrent vascular events after first-ever IS, and the extent to which these factors can be modified, which implicates the potential of reducing this risk,...

show abstract

“…A number of studies have provided substantial evidence for a strong relationship between right-to-left shunts (RLS) and migraine and cryptogenic stroke [1]–[3]. However, the mechanisms underlying this relationship are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Compromised Dynamic Cerebral Autoregulation in Patients with a Right-to-Left Shunt: A Potential Mechanism of Migraine and Cryptogenic Stroke

et al. 2014

View full text Add to dashboard Cite

Background and PurposeThe relationship between right-to-left shunts (RLS) and migraine and cryptogenic stroke is not well understood. In this study, we investigated whether RLS are associated with impairment of dynamic cerebral autoregulation (dCA), which may play a role in migraine and cryptogenic stroke.MethodsSixty-six migraineurs were enrolled in the study, including 36 non-RLS patients and 30 RLS patients. Non-invasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each patient by using transcranial Doppler and servo-controlled plethysmograph, respectively. Transfer function analysis was applied to derive autoregulatory parameters of gain, phase difference (PD), and autoregulation index.ResultsThe PD in migraineurs with RLS was 50.6±22.9 degrees, which was significantly lower than that observed in the non-RLS group (67.2±18.2 degrees, P<0.001). The PD in the large RLS group (45.4±22.6 degrees) was significantly lower than that of the small RLS group (64.9±17.1 degrees, P<0.01) and non-RLS group (P<0.001); however, the PD in the small RLS group was similar to that of the non-RLS group. The PD in the permanent group (48.8±19.9 degrees) was similar to that of the latent group (52.6±26.1 degrees), and both were significantly lower than that of the non-RLS group (P<0.05). The autoregulation index results were similar to the PD findings.ConclusionsdCA is impaired in migraineurs with large RLS, and this may represent a potential mechanism linking RLS, migraine, and cryptogenic stroke.

show abstract

Predictors of Migraine Subtypes in Young Adults With Ischemic Stroke

Cited by 60 publications

References 28 publications

Migraine with aura: which patients are most at risk of stroke?

Migraine with aura: which patients are most at risk of stroke?

Predictors of Long-Term Recurrent Vascular Events After Ischemic Stroke at Young Age

Compromised Dynamic Cerebral Autoregulation in Patients with a Right-to-Left Shunt: A Potential Mechanism of Migraine and Cryptogenic Stroke

Contact Info

Product

Resources

About