Migraine With Aura 'Major' Contributor to All Stroke Types

Pauline Anderson

June 27, 2013

BOSTON, Massachusetts — Migraine with aura is just as strong a stroke risk factor as elevated systolic blood pressure, obesity, and smoking, a new study suggests.

"I'm really comparing migraine with aura to hypertension, obesity, diabetes, etc, and the results indicate that migraine with aura is a very strong relative contributor to all subtypes of stroke when you take the other major risk factors into account," said lead author Tobias Kurth, MD, director of research, Neuroepidemiology, Institut national de la santé et de la recherche médicale (INSERM), Bordeaux, France, adjunct associate professor of epidemiology, Harvard School of Public Health, and associate epidemiologist, Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

"A history of migraine with aura should be considered an important risk marker for strokes of any kind," the authors conclude.

Dr. Kurth presented his research here at the 2013 International Headache Congress (IHC).

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The prospective cohort study included 27,860 women aged 45 years and older who were participating in the Women's Health Study and were free of cardiovascular disease at baseline. The women provided information on migraine and lipid measurements.

At the beginning of the study, 5130 women reported migraine, 40% of whom reported migraine with aura. During a 15-year follow-up, researchers confirmed 528 strokes: 430 ischemic, 96 hemorrhagic, and 2 unknown. The overall incidence rates per 1000 women per year were 1.2 for total stroke, 1.0 for ischemic stroke, and 0.2 for hemorrhagic stroke.

Migraine with aura was a strong contributor of risk for any type of stroke, with the incidence rates per 1000 women per year, adjusted for numerous variables, similar to those of other known risks factors, including systolic blood pressure of 180 mmHg or greater, body mass index of 35 kg/m2 or more, history of diabetes, family history of myocardial infarction, or smoking.

"Our data show migraine with aura is at least as strong as systolic blood pressure of 180 mm Hg , being heavily obese, having a history of diabetes, or current smoking, so it holds up with the biggies," commented Dr. Kurth. "That's a new piece that we haven't looked at before."

He added that migraine with aura is "not as a minor risk factor as we thought."

Table. Women's Health Study: Incidence of Stroke per 1000 Women per Year by Risk Factor

Risk Factor Total Stroke Ischemic Stroke Hemorrhagic Stroke
Migraine with aura 4.3 3.4 0.8
Systolic blood pressure ≥ 180 mmHg 3.7 3.1 0.5
Body mass index ≥ 35 kg/m2 3.2 2.5 0.8
History of diabetes 3.9 3.3 0.7
Family history of myocardial infarction 2.9 2.2 0.6
Smoking 2.9 2.5 2.5

 

Dr. Kurth sees these new findings as a positive new development because patients who have migraine with aura now know that they're potentially at increased risk and can discuss with their physician how to reduce that risk.

What's "still up for discussion" is the factor or factors related to migraine with aura that increase stroke risk. According to Dr. Kurth, the mechanisms are probably complex and could involve genetics, cerebrovascular function, and/or an interaction with other risk factors.

The link between migraine with aura and stroke risk probably also applies to men, said Dr. Kurth.

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