Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies

Abstract

Dozens of observational studies and two meta-analyses have investigated the association of migraine with the risk of stroke, but their results are inconsistent. We aimed to quantitatively evaluate the relationship between migraine and stroke risk by performing a meta-analysis of prospective cohort studies. PubMed and Embase were searched through July 2016 to identify studies that met pre-stated inclusion criterion and reference lists of retrieved articles were also reviewed. Information on the characteristics of the included study, risk estimates, and control for possible confounding factors were extracted independently by two authors. The random-effects model was used to calculate the pooled risk estimates. Eleven prospective cohort studies involving 3371 patients with stroke and 2,221,888 participants were included in this systematic review. Compared with non-migraineurs, the pooled relative risks of total stroke, hemorrhagic stroke, and ischemic stroke for migraineurs were 1.55 [95% confidence interval (CI) 1.38-1.75], 1.15 (95% CI 0.85-1.56), and 1.64 (95% CI 1.22-2.20), respectively. Exception of any single study did not materially alter the combined risk estimate. Integrated epidemiological evidence supports that migraine should be associated with the increased risk of total stroke and ischemic stroke, but the relationship between migraine and the risk of hemorrhagic stroke is not of certainty.

Migraine and Ischemic Stroke in Women. A Narrative Review

“…The studies with data on migraine subtype 28,31,33 reported that stroke risk was associated with MWA, a finding first reported in a small 1989 case‐control study 34 . Over the ensuing years, the aura‐ischemic stroke connection has been further corroborated in multiple case‐control studies, and prospective cohort studies, as well as 5 meta‐analyses (Table 2), 3‐7 one of which included a study of children ages 2‐18 years 6,35 . All meta‐analyses reported an association of ischemic stroke with migraine overall and with MWA, but not with migraine without aura (MWoA) 3‐7 .…”

“…Over the ensuing years, the aura‐ischemic stroke connection has been further corroborated in multiple case‐control studies, and prospective cohort studies, as well as 5 meta‐analyses (Table 2), 3‐7 one of which included a study of children ages 2‐18 years 6,35 . All meta‐analyses reported an association of ischemic stroke with migraine overall and with MWA, but not with migraine without aura (MWoA) 3‐7 . After publication of the 2018 meta‐analysis, 7 a large, prospective Danish cohort study showed increased risk of ischemic stroke with migraine (adjusted HR 2.26; 95% CI: 2.11‐2.41), particularly in women and those with aura 36 .…”

“…Migraine and ischemic stroke are both highly prevalent and disabling conditions, affecting women more commonly than men, although with a 3:1 ratio, female predominance is more striking in migraine 1,2 . Only 10% of ischemic strokes occur in persons under 50 years, 1 the age group most commonly affected by migraine, yet, numerous case‐control and cohort studies have demonstrated an independent association between these 2 conditions in the young 3‐7 . Migrainous infarction, defined by ischemic stroke occurring during a typical aura, is relatively rare 8‐11 .…”

Posterior circulation ischaemic stroke

“…Migraine presents particular diagnostic quandaries: migraineurs are more likely to develop headache secondary to acute ischaemia78; those with aura have a higher incidence of stroke1213; migraine is more often associated with carotid and vertebral artery dissection14; and migraine can cause transient neurological deficits without headache (acephalgic migraine or “late-life migraine accompaniments”) 15…”

Migraine Age of Onset and Association With Ischemic Stroke in Late Life: 20 Years Follow‐Up in ARIC

“…Migraine is a chronic neurological disorder with episodic headaches which usually start earlier in life. Migraine, especially migraine with aura (MA), is associated with increased risk of ischemic stroke, and higher risk of stroke in migraineurs younger than 45 years of age . The risk of stroke is higher with a higher frequency of migraine in young women .…”