Association Between Migraine and Cervical Artery Dissection

Abstract

IMPORTANCEAlthough sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS).OBJECTIVE To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD. DESIGN, SETTING, AND PARTICIPANTSA prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine. MAIN OUTCOMES AND MEASURESFrequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS. RESULTSOf the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P < .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95% CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95% CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95% CI,). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P > .99). CONCLUSIONS AND RELEVANCEIn patients with IS aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with CEAD. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms.

Risk of ischaemic stroke in patients with migraine: a longitudinal follow-up study using a national sample cohort in South Korea

“…Consistent with the findings from patients reporting migraine with aura, participants who reported migraine without aura had an increased adjusted HR of 1.15 (95% CI=1.06 to 1.24) for ischaemic stroke compared with the control group. Notably, a significant association was observed in cases of ischaemic stroke resulting from cervical artery dissection 36. In addition, genetic overlaps among subjects with migraine without aura, large artery stroke, and cardioembolic stroke have been identified 37.…”

Migraine and risk of stroke

“…The association between migraine and CeAD seems to be stronger for MO, for men and for the younger age groups. 133 Among patients with CeAD, being an individual with migraine had no influence on the occurrence of cerebral infarction, on the type of dissection (vertebral or carotid), the number of dissected vessels or on the clinical outcome, or occurrence of complications. In follow-up studies of patients with CeAD, mostly with ischaemic manifestations, people with migraine may experience improvement or even cessation of migraine attacks.…”

Pathophysiological Bases of Comorbidity in Migraine

“…(Li et al, 2015 ). As a further complication, migraine with visual aura is a risk factor for atrial fibrillation (Sen et al, 2018 ), while the relation between migraine and carotid artery dissection is still elusive, although they may share a common genetic substrate (Malik et al, 2016 ; De Giuli et al, 2017 ; Kok et al, 2018 ).…”