Diffusion-weighted lesions in acute ischaemic stroke patients with migraine

Abstract

Objectives -There is increasing knowledge about an association between migraine and ischaemic stroke. Cortical spreading depression (CSD) is the probable biological substrate of migrainous aura. To investigate the influence of CSD on the apparent stroke -migraine association, we hypothesized that magnetic resonance (MR) diffusion weighted images of acute ischaemic stroke patients would reveal an association between small cortical infarctions and migraine. Methods -We included all patients admitted to the Bergen stroke unit between 2006 and 2012 with verified acute ischaemic stroke by MR imaging. Patients were grouped in a migraine and a no-migraine group. Baseline data and clinical characteristics were analysed between the groups. Imaging data were analysed with respect to infarct location and size. Multivariate analyses were performed to adjust for confounders and provide risk estimates for observed associations. Results -A total of 1703 subjects were enrolled, 787 subjects were excluded due to uncertain or unobtainable migraine diagnosis, leaving 196 and 720 subjects in the migraine and nomigraine group, respectively. The migraine group was younger and included a higher proportion of females. There were more infarctions due to cardio-embolism (P = 0.015) and fewer due to small vessel disease (P = 0.018) in the migraine group. A higher rate of patients in the migraine group presented symptoms from the posterior circulation (P = 0.008). Migraine was associated with cortical infarctions (OR 1.8 CI: 1.3-2.5, P = 0.001). Migraine was also associated with small infarctions (OR 1.9 CI: 1.04-3.5, P = 0.038). Conclusions -Migraine was associated with small cortical infarctions. This association may be due to cortical spreading depression.

History of Migraine and Volume of Brain Infarcts: The Italian Project on Stroke at Young Age (IPSYS)

“…Actually, only two previous analyses have attempted to provide information on the association between migraine and lesion volume from acute cerebral ischemia in humans. The first is a retrospective analysis of the Norwegian Stroke Research (NORSTROKE) registry [28], which suggested that, as opposed to what observed in our study, migraine may be associated with smaller volume of acute infarcts. The second is a single-center North American study conducted on a relatively small group of acute ischemic stroke patients showing, as suggested from the present analysis, an increased lesion volume among migraineurs with aura [29].…”

Spreading Depolarization May Link Migraine and Stroke

“…Migraineurs among stroke patients were younger and more often females, and a higher proportion of infarcts was due to cardio‐embolism in migraineurs compared to non‐migraineurs. Migraine was associated with small cortical infarctions, suggesting an increased viability threshold with a high risk of infarction in response to small ischemic events in migraine‐susceptible brains . Other studies further support the concept that cerebral hyperexcitability may increase vulnerability to cerebral ischemia.…”

Influences of hyperlipidemia history on stroke outcome; a retrospective cohort study based on the Kyoto Stroke Registry

“…However, since treatment according to the guidelines is performed and the governmental medical insurance for the whole nation covers all people in Japan, a treatment bias is not very much likely. Embolism could lead a poor outcome without hyperlipidemia [ 22 , 23 ]. However, influence of embolism should be predominantly on CI.…”