Migraine With Aura Ups Cardioembolic Stroke Risk

Megan Brooks

February 25, 2016

LOS ANGELES — A new study provides more evidence that migraine with aura is associated with an increased risk for ischemic stroke and, in particular, cardioembolic stroke.

"There was a significant association with migraine with aura with ischemic stroke overall, and when we go down to the subtypes, the association was the most strong and significant with the cardioembolic type of stroke," Souvik Sen, MD, MPH, the study's lead author and a neurologist at the University of South Carolina School of Medicine in Columbia, said here at the International Stroke Conference (ISC) 2016.

Dr Souvik Sen

"If we are going to prevent people with migraines with aura from having a stroke, it's important to know what types of stroke they're having and then be vigilant about it," Dr Sen added in a conference news release.

The findings are based on 12,844 adults aged 45 to 64 years from the long-running Atherosclerosis Risk in Communities (ARIC) study. During the third clinical visit, 12.7% of participants reported migraine, of whom 29% had migraine with aura, and 8.5% reported nonmigraine headaches.

Between 1987 and 2012, a total of 817 ischemic strokes occurred, of which 51% were thrombotic, 27% were cardioembolic, and 22% were lacunar stroke.

Patients with migraine with aura had a greater than 2-fold increased risk for ischemic stroke compared with patients with migraine without aura (unadjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.6 - 3.6; P < .0001). The results held up after adjustment for stroke risk factors.

Migraine with aura had a stronger association with cardioembolic stroke (OR, 3.3; 95% CI, 1.4 - 8; P = .009) than with thrombotic stroke (OR, 2.0; 95% CI, 1.2 - 3.4; P = .01). No significant association was observed between migraine with aura and lacunar stroke.

"When we're talking about the cardioembolic stroke, we mean a stroke that came from the heart. That might be somebody who has atrial fibrillation, they might have heart failure, they might have a clot in the heart. All those are categorized as cardioembolic strokes, based on definition," Dr Sen said.

These findings, he added, emphasize the "importance of specific diagnostic testing to assess for cardioembolism and stroke prevention in migraine with aura patients."

Telling Results but Questions Remain

Noah Rosen, MD, director, Northwell Health's Headache Center in Great Neck, New York, who wasn't involved in the study, told Medscape Medical News, "There have been a couple of studies linking migraine (and particularly migraine with aura) to an increased risk of strokes. The study by Dr Sen is particularly interesting because it further breaks down what types of strokes that we may see in this population. The data is suggestive of an increased risk for cardioembolic and thrombotic strokes, but no clear association with lacunar infarcts."

American Stroke Association spokesperson Brian Silver, MD, also noted that prior studies have shown a link between migraines with aura and stroke, "but what this study is specifically telling us is that there are certain mechanisms which may link migraine with aura and stroke. This is I think a first step in terms of trying to understand why it is that people with migraine with aura are at increased risk for stroke."

An "issue that comes up is whether we should treat patients with migraine with aura as stroke surrogates," added Dr Silver, director of the Stroke Center at Rhode Island Hospital and associate professor of neurology at The Warren Alpert Medical School of Brown University in Providence, Rhode Island.

"A lot of times we get questions as to whether or not somebody with migraine with aura should take an aspirin daily. That also remains to be answered. I think what would be an excellent study to do would be to randomly allocate people to an aspirin a day or an aspirin and a statin a day if they have migraine with aura to see whether that reduces the risk of stroke compared to people who don't take that type of prevention medication if they have migraine with aura," Dr Silver said.

The study was funded by SmartState SC Centers of Economic Excellence and the National Heart, Lung, and Blood Institute. The authors have disclosed no relevant financial relationships.

International Stroke Conference (ISC) 2016. Poster 3918/TP179. Presented February 17, 2016.

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