Migraine and Cerebrovascular Atherosclerosis in Patients With Ischemic Stroke
Hendrikus J A van Os1, Inge A Mulder2, Alexander Broersen2
1From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.). h.j.a.van_os@lumc.nl.
Background And Purpose:
Migraine is a well-established risk factor for ischemic stroke, but migraine is also related to other vascular diseases. This study aims to investigate the association between migraine and cerebrovascular atherosclerosis in patients with acute ischemic stroke.
Methods:
We retrieved data on patients with ischemic stroke from the DUST (Dutch Acute Stroke Study). Migraine history was assessed with a migraine screener and confirmed by telephone interview based on the ICHD criteria (International Classification of Headache Disorders). We assessed intra- and extracranial atherosclerotic changes and quantified intracranial internal carotid artery calcifications as measure of atherosclerotic burden on noncontrast computed tomography and computed tomographic angiography. We calculated risk ratios with adjustments for possible confounders with multivariable Poisson regression analyses.
Results:
We included 656 patients, aged 18 to 99 years, of whom 53 had a history of migraine (29 with aura). Patients with migraine did not have more frequent atherosclerotic changes in intracranial (51% versus 74%; adjusted risk ratio, 0.82; 95% confidence interval, 0.64-1.05) or extracranial vessels (62% versus 79%; adjusted risk ratio, 0.93; 95% confidence interval, 0.77-1.12) than patients without migraine and had comparable internal carotid artery calcification volumes (largest versus medium and smallest volume tertile, 23% versus 35%; adjusted risk ratio, 0.93; 95% confidence interval, 0.57-1.52).
Conclusions:
Migraine is not associated with excess atherosclerosis in large vessels in patients with acute ischemic stroke. Our findings suggest that the biological mechanisms by which migraine results in ischemic stroke are not related to macrovascular cerebral atherosclerosis.
Insights
Migraine does not increase cerebrovascular atherosclerosis in acute ischemic stroke patients. The study suggests migraine
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Migraine is a known risk factor for ischemic stroke.
- Migraine's association with other vascular diseases is under investigation.
Purpose of the Study:
- To examine the link between migraine and cerebrovascular atherosclerosis.
- To assess atherosclerotic burden in patients with acute ischemic stroke and a history of migraine.
Main Methods:
- Data from the Dutch Acute Stroke Study (DUST) was analyzed.
- Migraine history was confirmed using International Classification of Headache Disorders (ICHD) criteria.
- Intra- and extracranial atherosclerosis and carotid artery calcifications were quantified using CT and CT angiography.
Main Results:
- No significant difference in intracranial or extracranial atherosclerotic changes was found between migraineurs and non-migraineurs.
- Patients with migraine showed comparable internal carotid artery calcification volumes.
- Adjusted risk ratios indicated no increased atherosclerosis in patients with migraine.
Conclusions:
- Migraine is not associated with increased large vessel atherosclerosis in acute ischemic stroke patients.
- The mechanisms linking migraine to ischemic stroke likely do not involve macrovascular cerebral atherosclerosis.
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