Migraine With Aura Tied to Higher Stroke Risk

Middle-aged and older adults who had migraine with aura had a greater risk of subsequent stroke, a study of 11,000 people showed.

Over 6 years, migraine with aura was associated with a 73% higher risk of ischemic stroke compared with no migraine (HR 1.73, 95% CI 1.12-2.65), reported Adam Sprouse-Blum, MD, PhD, of the University of Vermont in Burlington, and co-authors. No increased stroke risk was seen for migraine without aura (HR 1.10, 95% CI 0.70-1.72) or migraine overall (HR 1.35, 95% CI 0.98-1.87).

However, migraine overall — with or without aura — more than tripled ischemic stroke risk in men younger than 72 (HR 3.67, 95% CI 1.96-6.88), Sprouse-Blum and colleagues reported in Neurology Open Access. This relationship did not emerge in women or in older men.

“Our result that middle-aged and older male participants under age 72 had a much higher risk of stroke was unexpected since previous research in young people has shown that stroke disproportionately affects female individuals,” Sprouse-Blum said in a statement.

More research is needed to better understand these findings, he noted: “Should the findings be confirmed, it may be necessary to provide targeted stroke prevention counseling for individuals in this age group.”

Migraine, especially migraine with aura, has been tied to an increased risk of ischemic stroke in earlier work. A review of five meta-analyses found that migraine was associated with about a twofold higher relative risk of ischemic stroke, which was greatest among migraineurs with aura and among women, particularly women younger than age 45.

“Taken together, our results align with previous studies and suggest that the risk of incident ischemic stroke in middle and older age is 1.5 to 1.9 times higher for patients with migraine with aura, with no detectable difference in those with migraine without aura,” Sprouse-Blum and colleagues observed.

In the current analysis, researchers studied 11,381 people who were followed prospectively for incident stroke in the REGARDS cohort. Participants were 45 or older when they enrolled from 2003 to 2007.

REGARDS participants were questioned about their migraine history during a visit from 2013 to 2016, which served as the study baseline. They were asked whether a health professional had ever told them they had migraine headaches; those who answered yes were then asked whether their headaches were accompanied by visual changes.

The mean age of participants was 72 years; 55.2% were female and 34.8% were Black. Overall, 1,130 people had migraine, including 491 with aura and 639 without.

Over a mean follow-up of 6.4 years, 3.9% of people with migraine had incident ischemic stroke — including 4.7% with aura and 3.3% without aura — compared with 3.4% of people without migraine. Findings were adjusted for age, race, income, and stroke risk factors including hypertension, diabetes, smoking, atrial fibrillation, dyslipidemia, coronary artery disease, and body mass index.

“Although migraine with aura is associated with worse cardiovascular risk profiles, including higher Framingham Risk Scores, migraine is also linked to ischemic stroke in people without classical stroke risk factors, suggesting that nontraditional, migraine-specific mechanisms may also be involved,” Sprouse-Blum and co-authors noted.

The analysis had several limitations, the researchers acknowledged. Migraine classification was based on recall of clinician diagnosis, which was dependent on access to clinical care, they noted. “Given that migraine is underdiagnosed, some participants with migraine were likely misclassified as not having migraine,” they wrote.

The study also did not assess age at diagnosis and could not distinguish between recent and older migraine cases.