Risk of ischaemic stroke in people with migraine

Migraine with aura appears to be a risk factor for ischaemic stroke. Smoking or use of combined hormonal contraception appears to increase the risk multifold.

A systematic review and meta-analysis included 14 studies (11 case-control studies and 3 cohort studies). The risk of stroke was increased in people with migraine (relative risk 2.16, 95% confidence interval 1.89 to 2.48). This increase was consistent in people who had migraine with aura (RR 2.27, 95% CI 1.61 to 3.19) and migraine without aura (RR 1.83, 95% CI 1.06 to 3.15), as well as in those taking oral contraceptives (RR 8.72, 95% CI 5.05 to 15.05).

In another meta-analysis (25 trials) migraine as a risk factor of stroke was assessed. The demonstrated risk ratios were for migraine as a whole 1.73 (95% CI 1.31 to 2.29), for migraine with aura RR 2.16 (95% CI 1.53 to 3.03), and not statistically significant for patients without aura RR 1.23 (95% CI 0.90 to 1.69). Females were found to be at the highest risk (RR 2.08; 95% CI 1.13 to 3.84), females on oral contraceptives (RR 7.02; 95% CI 1.51 to 32.68), and in particular, if associated to the smoking habit (RR 9.03; 95% CI 4.22 to 19.34).

A third meta-analysis included 21 studies (13 case–control studies and 8 cohort studies) with a total of 622 381 patients. A total adjusted odds ratio of stroke in migraineurs was 2.04 (95% CI 1.72 to 2.76), for migraine with aura 2.25 (95% CI 1.53 to 3.33), migraine without aura 1.24 (95% CI 0.86 to 2.43) compared with non-migraineurs. OR for the female gender was 2.43 (CI 95% 1.80 to 3.27).

Another meta-analysis included 8 studies (4 case-control and 4 cohort studies) involving a total of 1600 hemorrhagic strokes. The overall pooled adjusted effect estimate of hemorrhagic stroke in subjects with any migraine versus control subjects was 1.48 (95% CI, 1.16 to 1.88; P=0.002; I² 54.7%); OR for migraine with aura 1.62 (95% CI, 0.87 to 3.03; P=0.129) was not significant. Compared with control subjects, the risk of hemorrhagic stroke was greater in females with any migraine (1.55; 95% CI, 1.16 to 2.07; P=0.003) and in female migraineurs aged less than 45 years (1.57; 95% CI, 1.10 to 2.24; P=0.012).

Comment: The quality of evidence is upgraded by large magnitude of effect.

Ədəbiyyat

1. Etminan M, Takkouche B, Isorna FC, Samii A. Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. BMJ 2005 Jan 8;330(7482):63.
2. Schürks M, Rist PM, Bigal ME et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009;339():b3914.
3. Spector JT, Kahn SR, Jones MR et al. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med 2010;123(7):612-24.
4. Sacco S, Ornello R, Ripa P et al. Migraine and hemorrhagic stroke: a meta-analysis. Stroke 2013;44(11):3032-8.