Introduction

The existing evidence strongly supports the association between migraine with aura and the increased risk of ischemic stroke. Nevertheless, the data illustrating the pathogenesis behind the augmented risk of ischemic stroke due to migraine with aura is scarce.

Aim

To determine the association of migraine (with or without aura) with ischemic stroke, and stroke subtypes in the population of the Atherosclerosis Risk in Communities (ARIC) study

Patient Profile

• Participants from the ARIC study (initiated in the year 1987) who had completed the third visit planned for the study (during the years 1993-1995) (n=12,758)
• All participants were without a history of ischemic stroke before inclusion in this analysis
• Age group: 45-64 years (mean age 59 years)
• Women; 56%
• History of migraine headaches; 12.6% of the study population (3.6% having migraine with visual aura and 9% having migraine without visual aura)
• Average duration of migraine history; 19 years

Methods

Study Design

• Ongoing, prospective, longitudinal community-based cohort study

Follow-Up

• 20 years

Outcomes

• All vascular events, including stroke over the subsequent 20 years. Stroke was classified into stroke subtypes as per the “National Survey of Stroke subtype classification criteria” (thrombotic brain infarction, lacunar infarction or cardioembolic stroke)

Results

• The prevalence of migraine was greater in women vs. men (3:1)
• The prevalence of stroke risk factors (hypertension, diabetes, and obesity) was slightly higher in migraine sufferers with visual aura vs. the rest of the population
• Migraine with visual aura was significantly associated with ischemic stroke when compared to individuals without headache (hazard ratio [HR] 1.7, p=0.008). On the contrary, migraine without visual aura was not associated with a significant increase in the risk of ischemic stroke (HR 1.2, p=0.28) as compared to individuals without headache.
• Of the 3 subtypes of ischemic stroke evaluated, migraine with visual aura had a significant association only with cardioembolic stroke but not with lacunar or non-lacunar thrombotic stroke (Table 1)

Conclusion

• Older (particularly, late-middle aged) individuals having migraine with visual aura had a significantly greater risk of cardioembolic stroke, but not of lacunar or non-lacunar thrombotic stroke
• Such an association was however not evident for migraine without visual aura and stroke over the period of 20 years
• Future prospective studies investigating the link between cardioembolic and cryptogenic stroke in migraine with visual aura are warranted to better understand the underlying pathogenesis

Neurology. Nov 9, 2016 (Published ahead of print); 10.1212/WNL.0000000000003428