Migraine as a risk factor for young patients with ischemic stroke: a case–control study

DOI: https://doi.org/10.1007/s10072- 017- 2810- 3

Abstract-Summary Studies have suggested a possible association of migraine and increased risk of ischemic stroke in young adults, particularly in smokers and in women who use oral contraceptive drugs.

We aimed to analyze the association between migraine and ischemic stroke in

young population in a hospital-based cohort.

Frequency of migraine was 30.2% among patients with stroke whereas 16.8% of

healthy subjects had migraine (p = 0.001).

Migraine with aura was significantly more common among patients with stroke compared to healthy subjects (18.3 vs 4.4%; p = 0.000) whereas the frequency of migraine without aura was similar in both groups (11.9 vs 12.4%).

Using logistic regression, migraine with aura was shown to be an independent risk factor for ischemic stroke in young population (p = 0.000) and separate analysis for gender demonstrated that it was only a risk factor for women (p = 0.009) but not for men (p = 0.107).

Migraine with aura was found to be more common in ischemic stroke in young

patients.

Introduction The association between migraine and stroke is complex and underlying mecha- nisms are not completely understood [399].

Migraine and ischemic stroke are both neurovascular disorders. Presence of patent foramen ovale (PFO) is also associated with both migraine and ischemic stroke; however, available data do not support a benefit for PFO clo- sure for patients with a cryptogenic ischemic stroke or transient ischemic attack and

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2 Mechanisms

a PFO without evidence for deep venous thrombosis [400] and likewise closure of PFO is not indicated for preventing stroke in patients with migraine, either [401].

Drugs used in the treatment of migraine allegedly cause ischemic stroke

[402, 403].

Given this information, migraine seems to be a risk factor and should probably

be sought in a young stroke patient.

We aimed to investigate this association in a hospital-based cohort of ischemic stroke by analyzing the frequency of migraine in young stroke patients and its asso- ciation with other risk factors for ischemic stroke.

Subjects and Methods Other risk factors such as hypertension (HT), diabetes mellitus (DM), hyperlipid- emia (HL), obesity, use of OCs, smoking, alcohol intake and family history of migraine were recorded according to the statements of patients or were retrieved from medical records.

Age, gender, presence and subtypes of migraine, family history of migraine, presence of risk factors (HT, DM, HL, smoking, alcohol, OC use, BMI) were com- pared between patients with ischemic stroke and healthy subjects without history of stroke.

Stroke and control groups were divided into decades to determine the distribu- tion of patients and healthy subjects in different age groups such as 15–25, 26–35, 36–45 and 46–50 years.

Age, family history of migraine, risk factors (HT, DM, HL, use of OCs, smoking,

use of alcohol, BMI) were compared between these four groups.

Relationship of migraine and stroke was analyzed and entered variables were gender, family history of migraine, HT, DM, HL, use of OCs, smoking, use of alco- hol and BMI.

Results There were 61 patients (30.2%) with migraine in the stroke group, whereas 42 (16.8%) healthy subjects had migraine (p = 0.001).

Comparisons of stroke patients with migraine, stroke patients without migraine, healthy subjects with migraine and healthy subjects without migraine showed that all groups had similar mean ages (p = 0.475).

Migraine was diagnosed in 8 of 19 stroke patients with CAD (42.1%) whereas in 53 of 183 stroke patients without CAD (29%) and this finding was not significant (p = 0.235).

Family history of migraine was significantly higher in stroke patients compared

to healthy subjects (31.7 vs 20.8%; p = 0.008).

It was also significantly higher in patients with stroke and healthy subjects expe-

riencing migraine compared to other groups (p = 0.000).

Discussion Important findings of our study are as follows: (1) migraine with aura was common in young patients with stroke; (2) migraine with aura was an independent risk factor for stroke in young women.

2.3 Comorbidities

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Migraine is considered as a risk factor for ischemic stroke, especially in young

patient population, which is confirmed in our study.

The finding of the relationship between migraine with aura and ischemic stroke in patients with a low Framingham risk score also supported that migraine would be an independent risk factor [404].

We did not find any relationship between migraine and the other risk factors in our study confirming the suggestion that migraine was an independent risk factor in young stroke patients reported in this article.

Migraine with aura is an independent risk factor for ischemic stroke in

young women.

The other risk factors for ischemic stroke should be carefully assessed in young

people with migraine with aura.

Acknowledgement A machine generated summary based on the work of Abanoz, Yasin; Gülen Abanoz, Yeşim; Gündüz, Ayşegül; Uludüz, Derya; İnce, Birsen; Yavuz, Burcu; Göksan, Baki2017 in Neurological Sciences.

Comorbidity of gastrointestinal disorders, migraine, and tension-type headache: a cross-sectional study in Iran