Migraine as a risk factor for young patients with ischemic stroke: a case–control study

Abstract

Studies have suggested a possible association of migraine and increased risk of ischemic stroke in young adults, particularly in smokers and in women who use oral contraceptive drugs. We aimed to analyze the association between migraine and ischemic stroke in young population in a hospital-based cohort. We included 202 consecutive patients with the diagnosis of ischemic stroke who were between 15 and 50 years and age- and gender-matched 250 volunteers with no history of stroke. All participants were interviewed using a questionnaire for migraine. Localization of ischemic lesion was classified as anterior and posterior circulation according to neuroimaging findings. The cause of ischemic lesion and all risk factors were recorded. Undetermined etiology was the most frequent (43.1%) and the most common determined cause was cardioembolism (22.3%) in young stroke patients. Frequency of migraine was 30.2% among patients with stroke whereas 16.8% of healthy subjects had migraine (p = 0.001). Migraine with aura was significantly more common among patients with stroke compared to healthy subjects (18.3 vs 4.4%; p = 0.000) whereas the frequency of migraine without aura was similar in both groups (11.9 vs 12.4%). Using logistic regression, migraine with aura was shown to be an independent risk factor for ischemic stroke in young population (p = 0.000) and separate analysis for gender demonstrated that it was only a risk factor for women (p = 0.009) but not for men (p = 0.107). Migraine with aura was found to be more common in ischemic stroke in young patients. It was an independent risk factor in women.

Migraine in Women

“…104,105 There are no data to date that suggest that effective treatment of migraine with aura to reduce frequency actually reduces this risk. 106 Hemorrhagic stroke appears to be consistently increased in MA, MO, and uncategorized migraine. 109 The mechanisms of the relationship between migraine with aura and stroke are complex; hormonal influences are thought to contribute.…”

“…104 This risk is primarily attributed to migraine with aura most typically in younger women, and it appears to be independent of other risk factors. [105][106][107] A meta-analysis reported that the risk of stroke was doubled in those with migraine with aura and tripled in the female cohort. 108 It also appears that aura frequency of more than once a month as well as a life-time duration of less than a year is associated with an even higher stroke risk.…”

“…111,112 As for many vascular risk factors, the risk appears to be compounded in the presence of other known risk factors. 106 COCs alone pose a stroke risk, so there is much concern about women with aura using COC and increasing their stroke risk. Guidelines of the American College of Obstetricians and Gynecologists state that the risks of COCs are unacceptable in this group, whereas COCs are not contraindicated in migraine without aura in healthy, nonsmoking women 35 years of age or under.…”

The association between tinnitus and the risk of ischemic cerebrovascular disease in young and middle-aged patients: A secondary case-control analysis of a nationwide, population-based health claims database

“…The prevalence of standard modifiable vascular risk factors in young stroke patients is also different from that of older patients, in which dyslipidemia, smoking, and hypertension are highly prevalent in the young stroke population [ 11 ]. In addition, migraine with aura was found to be an independent risk factor for ischemic stroke in young population and in women [ 12 ].…”

Headache in Pregnancy, the Puerperium, and menopause

“…Estrogen plays a central role in the pathophysiology of migraine headaches, 1 and exogenous estrogen use can be a risk factor for ischemic stroke in a subset of those with migraine (namely, migraine with aura). [2][3][4] Specifically, the drop of estrogen during the luteal phase of the menstrual cycle, the drop of estrogen between pregnancy and the postpartum period, and the chaotic fluctuations in estrogen during the perimenopausal period are associated with an increase in headache frequency. Pregnancy induces various physiologic changes, which can be hemodynamic (increase in plasma volume), cardiac (increase in cardiac output, stroke volume, heart rate), vascular (vessel wall remodeling and endothelial cell dysfunction), or hematologic (late pregnancy and early postpartum is a physiological hypercoagulable state).…”