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Ischemic stroke subtypes and migraine with visual aura in the ARIC study.
X Michelle Androulakis1, Nishanth Kodumuri1, Lauren D Giamberardino1
1From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
Migraine with visual aura, but not without, is linked to a higher risk of ischemic stroke, particularly cardioembolic stroke, in older adults. This 20-year study highlights a specific stroke risk for individuals experiencing visual aura with their migraines.
Area of Science:
- Neurology
- Epidemiology
- Cardiovascular Medicine
Background:
- Migraine is a prevalent neurological disorder.
- Stroke is a leading cause of disability and mortality.
- The association between migraine and stroke risk, including subtypes, requires further investigation.
Purpose of the Study:
- To examine the relationship between migraine and ischemic stroke risk.
- To investigate the association between migraine and specific ischemic stroke subtypes (cardioembolic, lacunar, thrombotic).
- To analyze these associations within the context of the Atherosclerosis Risk in Communities (ARIC) study.
Main Methods:
- Prospective, longitudinal community-based cohort study.
- Migraine history ascertained through interviews (1993-1995).
- Follow-up for 20 years for all vascular events, including adjudicated stroke subtypes.
- Cox proportional hazards models adjusted for stroke risk factors were employed.
Main Results:
- A significant association was found between migraine with visual aura and ischemic stroke (HR 1.7, p=0.008).
- Migraine without visual aura showed no significant association with ischemic stroke (HR 1.2, p=0.28).
- Migraine with visual aura was significantly associated with cardioembolic stroke (HR 3.7, p=0.003), but not other subtypes.
Conclusions:
- Migraine with visual aura in late middle age is associated with an increased risk of cardioembolic stroke.
- Migraine with visual aura, not without, predicts increased stroke risk over 20 years.
- Findings are specific to older individuals with migraine and visual aura.
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