Migraine improvement after spontaneous cervical artery dissection the Italian Project on Stroke in Young Adults (IPSYS)

Giuli, Valeria De; Graziano, Francesca; Zini, Andrea; Zedde, Marialuisa; Patella, Rosalba; Lodigiani, Corrado; Marcheselli, Simona; DeLodovici, Maria Luisa; Paciaroni, Maurizio; Casetta, Ilaria; Giorli, Elisa; Adami, Alessandro; Braga, Massimiliano; Casella, Carmela; Giossi, Alessia; Silvestrelli, Giorgio; Tancredi, Lucia; Lotti, Enrico Maria; Poli, Loris; Caria, Filomena; Piras, Valeria; Cucurachi, L; Gamba, Massimo; Grassi, Mario; Padovani, Alessandro; Pezzini, Alessandro

doi:10.1007/s10072-018-3578-9

Cited by 20 publications

(18 citation statements)

References 9 publications

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“…In order to fully understand the benefits and risks of spinal manipulation for migraineurs, more rigorous assessments of potential adverse events should be performed. Adequate monitoring of adverse events is particularly important in this population because of concerns that cervical manipulation may be associated with cervical artery dissection and the increased risk of cervical artery dissection among migraineurs . Further understanding of the potential risks and benefits of spinal manipulation for migraineurs may help migraineurs and their physicians determine the best course of care.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta‐Analysis

et al. 2019

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Background Several small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta‐analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability. Methods PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine‐related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta‐analytic methods were employed to estimate the effect sizes (Hedges’ g) and heterogeneity (I2) for migraine days, pain, and disability. The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool. Results Our search identified 6 RCTs (pooled n = 677; range of n = 42‐218) eligible for meta‐analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta‐analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges’ g = −0.35, 95% CI: −0.53, −0.16, P < .001) as well as migraine pain/intensity. Conclusions Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta‐analysis, we consider these results to be preliminary. Methodologically rigorous, large‐scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.

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Section: Discussionmentioning

confidence: 99%

The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta‐Analysis

et al. 2019

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“…MWoA was more common among stroke patients with CeAD than those without. A 2017 multicenter, 15‐year prospective cohort study of first‐ever stroke in young persons (IPSYS) found an association of MWoA that was strongest in men, and those under the age of 40 years 146 . The mechanisms connecting migraine to CeAD are unproven, but it is speculated that there is shared genetic susceptibility and endothelial dysfunction.…”

Section: Potential Mechanisms Of Migraine‐related Strokementioning

confidence: 99%

Migraine and Ischemic Stroke in Women. A Narrative Review

Tietjen

Maly

2020

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Objective/Background.-Migraine is associated with ischemic stroke. Women are 3-fold as likely as men to have migraine, and high estrogen states increase the risk of migraine with aura (MWA), venous thromboembolism (VTE), and of stroke. We review the epidemiological and mechanistic evidence of the migraine-stroke relationship and its risk factors, with a focus on women and conditions that exclusively or predominantly affect them.Methods.-We performed a search of MEDLINE/PubMed database, then a narrative review of the epidemiological evidence of the migraine-stroke relationship as well as the evidence for arterial, thrombophilic, and cardiac mechanisms to explain this connection. We examine the implications of this evidence for the diagnostic evaluation and treatment of MWA.Results.-MWA is associated with multiple stroke risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, atrial fibrillation, and patent foramen ovale. In women, MWA is also associated with biomarkers of endothelial activation, hormonal contraceptive use, pregnancy, and VTE. This suggests that a subset of auras may be secondary, that is, induced by ischemia related to microemboli or in situ thrombosis. MWA-associated ischemic stroke is more common in young (<45 years old) women with high frequency of migraine attacks, hormonal contraception use, and with pregnancy and preeclampsia. There is increasing evidence that cardioembolism, often in conjunction with thrombophilia, plays a prominent role in MWA-associated cerebral infarction.Conclusion.-The commonality of factors associated with MWA and with MWA-associated stroke suggest that persons with secondary, ischemia-induced aura may be at elevated risk of stroke. Although further research is needed, we recommend consideration of a diagnostic evaluation of MWA that mirrors the evaluation of transient ischemic attack, given that prophylactic treatment targeting the ischemic origin of secondary aura may prevent migraine as well as stroke.

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“…In a study examining the risk associated with migraine for different subtypes of strokes, an increased hazard for cardioembolic stroke was found, but the hazard ratio for lacunar and non-lacunar/non-cardioembolic stroke was not significant. 59,60 Migraine is not known to predispose to recurrence. 57,58 In the case of our patient, the etiology of the stroke was a cervical artery dissection, a stroke subtype also associated with migraine, with a recurrence rate between 5 and 10%.…”

Section: Expert Commentarymentioning

confidence: 99%

“…57,58 In the case of our patient, the etiology of the stroke was a cervical artery dissection, a stroke subtype also associated with migraine, with a recurrence rate between 5 and 10%. 59,60 Migraine is not known to predispose to recurrence. 61 There are a few published cases of cervical artery dissection in association with triptan use, but a causality link has not been demonstrated,the association may be with migraine and not with triptan use.…”

mentioning

confidence: 99%