Migraine With Aura Increases Risk for Ischemic Stroke Subtypes

Vestibular migraine
Vestibular migraine
The risk among people with migraine with aura was especially high for cardioembolic stroke.

LOS ANGELES — Compared to patients with migraine without aura, those who have migraine with aura (MA) demonstrate increased rates of thrombotic and cardioembolic stroke, according to a study presented at the 2016 International Stroke Conference.

“Our results indicate MA is significantly associated with increased risk of stroke both in men and women—twice as likely when compared with migraine without aura,” Souvik Sen, MD, MS, MPH, study investigator from the University of South Carolina School of Medicine, Columbia, South Carolina, said in an interview with Neurology Advisor. “After adjusting for the stroke risk factors, the risk of stroke in MA remained significant and twice as likely when compared to migraine without aura.”

According to study background, previous research had indicated that MA is an independent risk factor for ischemic stroke, leading Dr Sen and colleagues from South Carolina, North Carolina, and Maryland to evaluate whether MA is associated with specific ischemic stroke subtypes.

“South Carolina, North Carolina, and Georgia are located in the ‘buckle’ of the stroke belt, with one of the highest stroke related death rates in the country,” said Dr Sen on the catalyst of the study. “An unfortunate trend is that younger patients are having strokes leading to death and disability. As a part of the workup for young stroke, we are interested in MA and the type of stroke associated with this condition.”

The prospective cohort analysis involved 12 844 patients from the Atherosclerosis Risk In Communities (ARIC) study who completed an in-person headache questionnaire.

Researchers classified headaches as MA, migraine without aura, or non-migraine headaches, and strokes as thrombotic brain infarction, lacunar infarction, or cardioembolic stroke, with classification requiring evidence of sudden or rapid onset of neurological symptoms lasting ≥24 hours. Additionally, stroke diagnoses were ascertained via computer-derived diagnosis and physician medical record review, with a second physician reviewer adjudicating differences.

During the third ARIC study visit, Dr Sen and colleagues reported that 12.7% of patients had migraine, of whom 29% had MA, and 8.5% had non-migraine headaches.

Between 1987 and 2012, 817 ischemic strokes occurred, of which 51% were thrombotic, 27% cardioembolic, and 22% lacunar. Among those with MA, there was an 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).

“These results are in agreement with the previous studies that reported increased risk of stroke in MA,” Dr Sen said.

Moreover, individuals with MA were at increased risk for cardioembolic stroke (OR=3.3; 95% CI, 1.4-8; P=.009) vs. thrombotic stroke (OR=2; 95% CI, 1.2-3.4; P=.01). No significant association was observed between MA and lacunar stroke.

“As our results point to the significant association of stroke with migraine, it emphasizes the importance of specific diagnostic testing to assess for cardioembolism and stroke prevention in MA patients,” Dr Sen said. “These individuals should ask their primary care physicians about access to specific diagnostic testing such as echocardiogram with bubble studies or Holter monitoring for cardioembolism and additional stroke risk factors.”

He added that MA patients may benefit from the initiation of an 81 mg aspirin regimen, especially those who have additional stroke risk factors.

“Encouraging individuals with a history of MA to talk with their primary care physicians about specific cardioembolic stroke risk factors may aid in the effort of preventing stroke in young people,” Dr Sen said.

For more coverage of ISC 2016, go here.


Androulakis XM, Rosamond W, Yim E, et al. Poster T P179. Ischemic Stroke Subtypes and Relationship with Migraine in the Atherosclerosis Risk In Communities Study. Presented at: International Stroke Conference; Feb. 16-19, 2016; Los Angeles.