Info: Migraine Causes Stroke?

ASA: Migraine Linked to Increased Stroke in Young People
By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
February 03, 2005
Also covered by: MSNBC

Review

Preliminary results from the Stroke Prevention in Young Women study and a case control study from Italy confirm previous studies and suggest that migraine headaches are associated with increased risk of stroke in persons age 49 or younger. The risk is independent of oral contraceptive use or smoking history, and may be greatest for young women (18-49) with migraine accompanied by visual disturbances.

At a news briefing sponsored by the American Stroke Association, Steven Kittner, MD, MPH, a researcher and investigator for the Baltimore VA Medical Center and a professor of neurology at the University of Maryland School of Medicine, said that young women who have migraine with visual disturbance have a 25% to 70% higher risk for stroke than women who have no migraine headaches or women who have migraine without visual disturbances. "And the risk appears to be greatest for women who have some vision loss rather than women who have floaters or heat wave lines," he said.

A second study reported that migraine headaches are an independent risk factor for stroke in young people. Massimo Camerlingo, M.D., head of the neurologic unit at Policlinico San Marco in Osio Sotto, Italy said that migraine headaches are associated with 2.7 times greater risk for stroke among people in their 30s.

Kittner and his colleagues defined migraine patients as those who had five or more migraine headaches a year and migraine with aura was defined as patients who had two or more migraine headaches with visual disturbances during a year.

Camerlingo said that all of the patients who had migraine in his study "meet the criteria for migraine with aura," which Kittner said strengthens the case for migraine with aura as a risk factor.

Other significant findings in the women's study:

1. Stroke cases (n=542) were more likely to be hypertensive, diabetic, and smokers (all P<.05). 2. Women with migraine were more likely to be obese (P<.05). 3. Migraine with loss of vision was associated with 1.7 RR of stroke. Larry Goldstein, MD, a spokes person for the American Stroke Association, said in an interview that any person who experiences migraine with aura-especially new onset migraine with aura-"needs to be carefully evaluated to determine if it is true migraine or if there are other causes." Kittner seconded this recommendation noting that "any person without regard to age or gender who has new onset migraine with visual loss should have the symptoms investigated to rule out other medical conditions such as detached retina or TIA." Kittner said that persons with migraine-especially young women-should also "stop smoking, make sure their blood pressure is well controlled, eat a healthy diet and exercise." Camerlingo said blood pressure control is especially important for migraine sufferers-in his study persons with high blood pressure and migraine had an almost 9-fold increase in stroke risk. Other significant findings from the Italian study: The logistic regression model retained migraine (odds ratio 2.70, 95% CI 1.66-4.41); Hypertension (OR 9.10, 95% CI 4.17-19.89); and cardiopathy (OR 31.94, 95% CI 4.15-238.73) as factors independently related to stroke. Noting that some studies have suggested that birth control pills may increase the risk of stroke, "I suggest that women who have migraine should discuss the use of oral contraceptives with their physician. If they develop visual symptoms with migraine, they should discuss it again," Kittner said. Primary source: American Stroke Association International Conference 2005 Abstracts 320 and 338