Stroke territory and atherosclerosis in ischemic stroke patients with a history of migraine with aura

Abstract

IntroductionThe mechanisms subtending the increased stroke risk in migraine with aura (MA) are not fully understood. Our study aims to evaluate if the clinical profile in stroke patients with MA differentiates from those without MA.MethodsWe retrieved the prospective registered electronic clinical dossiers of adult patients younger than 60 years with acute ischemic stroke admitted in four hospitals between January 2016 and June 2022. Patients were classified by the history of MA (MA+ and MA–).ResultsWe identified 851 stroke patients (59 MA+, 6.9%). Compared to MA−, MA+ patients were characterized by younger age (44.0 ± 10.6 vs 50.1 ± 8.2 years), female sex (59.3% vs 29.0%), and affected by cryptogenic (OR 2.594 95% CI 1.483–4.537), and cerebellar stroke (OR 3.218 95% CI 1.657–6.250; p ≤ 0.001 for all comparisons). After adjusting for age and sex, MA+ patients presented less frequently hypertension (OR 0.349 95% CI 0.167–0.470; p=0.005) and dyslipidemia (OR 0.523 95% CI 0.280–0.974; p = 0.041). After adjusting also for risk factors, the MA+ group had less frequently symptomatic large vessel stenosis (OR 0.126 95% CI 0.017–0,924; p = 0.042) and clinical atherosclerosis (OR 0.103 95% CI 0.014–0.761; p = 0.026), while intima–media thickness did not differ (p = 0.395).DiscussionCryptogenic and cerebellar stroke and fewer vascular risk factors and clinical atherosclerosis seem to characterize stroke patients with MA.

Bibliometric Analysis of Research on Migraine-Stroke Association from 2013 to 2023

“…A recent multicenter cohort study showed that among all 851 patients with migrainous cerebral infarction, MA patients were more frequently women and younger in age. 41 It was also shown that for young men, migraine increased the risk of ischemic stroke similarly to that of women. 42 The risk of stroke in elderly migraineurs has also been explored, with conflicting results.…”

“… 53 Stroke patients with MA are also less likely to have hypertension, diabetes, and dyslipidemia, which implies that migraine-induced risk of stroke is independent. 41 , 55 , 56 However, dyslipidemia and smoking increase the Framingham risk score in migraineurs. 53 Notably, there are two conditions in which traditional vascular risk factors still play an important role in stroke attacks, one in patients with CADASIL and the other in pregnant patients with migraine headaches.…”

“…Most studies suggest that the increased risk of stroke from migraine is independent of large vessel atherosclerosis and traditional vascular risk factors. 37 , 41 , 55 , 69 A recent Mendelian randomization (MR) study found a link between genetic susceptibility to migraine and worse functional outcomes after ischemic stroke. 70 However, more MR studies failed to find a causal relationship between genetic susceptibility to migraine and stroke.…”

Autophagy may protect the brain against prolonged consequences of headache attacks: A narrative/hypothesis review

“…39 Hyperalgesia in migraine is underlined by several aspects, including neurons-glia crosstalk and disturbing the balance of the neurotransmitters in the nervous system by microglia, astrocytes, and satellite cells can induce migraine headaches; 40 however, not all aspects of the involvement of microglia in migraine are clear. Some studies report that migraine, especially migraine with aura, may be a risk factor for ischemic stroke (IS); 41,42 however, most of these studies were performed on elderly cohorts, in which cardiovascular burden might be so high that it could suppress the difference in the risk resulted from migraine status. 43 This may be the reason that certain studies detected a tendency only without a statistical significance.…”

“…Some studies report that migraine, especially migraine with aura, may be a risk factor for ischemic stroke (IS); 41,42 however, most of these studies were performed on elderly cohorts, in which cardiovascular burden might be so high that it could suppress the difference in the risk resulted from migraine status 43 . This may be the reason that certain studies detected a tendency only without a statistical significance 44 .…”