History of migraine associated with ischemic stroke
Tuesday, April 11, 2017
Cervical artery dissection (CEAD) is a common cause of ischemic stroke (IS) in younger adults, with a prevalence of up to 20 percent in younger patients and an annual incidence rate of 2.6 to 2.9 per 100,000.
The actual incidence of CEAD-IS may be even greater, as self-limited clinical symptoms may cause many cases to go undiagnosed. Previous studies suggest an association between CEAD-IS and migraines, particularly migraines without auras, but these studies were small.
Researchers in a new study intended to evaluate the link between CEAD-IS and migraine in younger adults using data gathered from a large registry of ischemic strokes.
The researchers performed a prospective cohort study of patients aged 18 to 45 who had a first-ever acute ischemic stroke and enrolled in the Italian Project on Stroke in Young Adults. Some of the patients had ischemic strokes due to cervical artery dissection (CEAD IS) and others suffered ischemic strokes unrelated to cervical artery dissection (non-CEAD IS). The scientists conducted their study between Jan. 1, 2000 and June 30, 2015.
The aim of the study was to determine whether the frequency of migraine and its subtypes differs between those patients CEAD IS and those with non-CEAD IS. The researchers also wanted to compare the characteristics of patients who had suffered cervical artery dissection both with and without migraine.
The researchers found that a history of migraine was more common in CEAD IS than in strokes from other etiologies.
At 30.8 percent versus 24.4 percent, migraine was more common in the participants in the CEAD IS group than in those in the non-CEAD IS group. The main reason for this difference was migraine without aura.
Compared with migraine with aura, migraine without aura was independently associated with ischemic stroke resulting from cervical artery dissection. The strength of the association between CEAD IS was higher in male participants (OR 1.99) and in those who were 39 years old or younger (OR 1.82).
Other risk factors, such as hypertension and diabetes, were the same between migraine and nonmigraine groups.
The researchers reviewed information from 2,485 patients in the registry. The mean age of participants was 36.8 years, and 46.8 percent of the participants were female. Of the patients entered into the study, 86.6 percent (2,151) had non-CEAD IS and 13.4 percent (334) had CEAD IS.
The study excluded patients with provoked ischemic strokes, such as those resulting from trauma, iatrogenic illnesses and cardiac surgery. All participants underwent standard workups for stroke, including Doppler carotid ultrasounds, angiography, coagulation testing and echocardiography.
Researchers determined CEAD through CT or MRI angiography. They used study physician assessment at presentation and follow-up to determine history of migraine.
This study is important because it includes a large cohort population of younger adults with stroke who received standardized care in the form of stroke workup and migraine diagnosis by neurologists involved in the study. The case-control design of the study may prevent assessment of causality, so there may be another unifying link not considered in this study.
In people aged 18 to 45 with ischemic stroke, migraine is consistently associated with cervical arterial dissection. This is especially true in migraine without aura. The results of this research suggests there are common features between CEAD IS and migraine that warrant further study to learn more about their underlying mechanisms.
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