Probable Migraine With Visual Aura and Risk of Ischemic Stroke

Abstract

Background and Purpose-Migraine with aura is associated with ischemic stroke, but few studies have investigated the clinical and anatomic features of this association. We assessed the association of probable migraine with and without visual aura with ischemic stroke within subgroups defined by stroke subtype, vascular territory, probable migraine characteristics, and other clinical features. Methods-Using data from a population-based, case-control study, we studied 386 women ages 15 to 49 years with first ischemic stroke and 614 age-and ethnicity-matched controls. Based on their responses to a questionnaire on headache symptoms, subjects were classified as having no migraine, probable migraine without visual aura, or probable migraine with visual aura (PMVA). Results-Women with PMVA had 1.5 greater odds of ischemic stroke (95% CI, 1.1 to 2.0); the risk was highest in those with no history of hypertension, diabetes, or myocardial infarction compared to women with no migraine. Women with PMVA who were current cigarette smokers and current users of oral contraceptives had 7.0-fold higher odds of stroke (95% CI, 1.3 to 22.8) than did women with PMVA who were nonsmokers and non-oral contraceptive users. Women with onset of PMVA within the previous year had 6.9-fold higher adjusted odds of stroke (95% CI, 2.3 to 21.2) compared to women with no history of migraine. Conclusions-PMVA was associated with an increased risk of stroke, particularly among women without other medical conditions associated with stroke. Behavioral risk factors, specifically smoking and oral contraceptive use, markedly increased the risk of PMVA, as did recent onset of PMVA.

Cardiovascular Disease Risk Profile in Japanese Midlife Migraineurs

“…A recent Icelandic cohort study of midlife migraineurs also has shown that female MA is correlated with latelife cerebellar infarct-like lesions on magnetic resonance imaging [13]. Causative mechanism of those vascular disorders might contribute to prothrombotic actions, CVD risk factors, vascular reactivity, specific gene variants, congenital heart diseases, migraine attack frequency, migrainespecific treatment and pathophysiological involvements of the migraine [5,9,[14][15][16]. Major prospective studies evaluated CVD risk factors in large number of migraineurs and non-migraineurs [10,13,17,23].…”

“…Migraine is associated with stroke and cardiovascular disease (CVD) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Potential mechanisms of increased risk for ischemic stroke and CVD have been postulated in migraineurs [5,9,[14][15][16].…”

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

“…Indeed, there is a greater risk of ischemic stroke (relative risk, 4.8) among cigarette-smoking women with a cigarette-smoking spouse vs those with a nonsmoking spouse. Finally, smoking modifies the influence of oral contraceptives on stroke risk, as there seems to be a 7-fold rise in risk among persons who both smoke and use oral contraceptives [38].…”

Migraine and preterm birth

“…3 Ischemic stroke is more common in women with than without migraine, 4,5 and risk is increased in those taking oral contraceptives. 6 There is a striking increase in frequency of pregnancy-associated stroke in women with a history of migraine, although the absolute level of that risk is low. 7 Migraine is associated with pre-eclampsia, [8][9][10][11] itself a marker of risk for later ischemic stroke 12 Other disorders influenced by migraine history include endometriosis and metrorrhagia.…”