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Shorter visual aura characterizes young and middle-aged stroke patients with migraine with aura
Claudia Altamura1, Angelo Cascio Rizzo2, Giovanna Viticchi3
1Headache and Neurosonology Unit, Neurology, Università Campus Bio-Medico Di Roma, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy. c.altamura@unicampus.it.
Objective:
To identify the clinical profile and aura characteristics of patients with Migraine with Aura (MwA) having acute cerebral ischemia, we compared stroke phenotype and risk factors in stroke patients with (S+MwA+) or without (S+MwA-) MwA and aura features in MwA patients with (S+MwA+) or without (S-MwA+) stroke.
Methods:
In this retrospective multicenter case-control study, we reviewed stroke phenotypes and vascular risk factors in S+MwA+ and S+MwA- patients younger than 60 years and risk factors and aura type, duration, onset age, and the frequency in the previous year in S+MwA+ patients and S-MwA+ subjects matched for age and disease history, investigated for patent foramen ovale (PFO).
Results:
539 stroke (7.7% S+MwA+) and 94 S-MwA + patients were enrolled. S+MwA+ patients were younger (p =.0.004) and more frequently presented PFO [OR 4.89 (95% CI 2.12-11.27)], septal interatrial aneurism [OR 2.69 (95% CI 1.15-6.27)] and cryptogenic ischemic stroke (CIS) [OR 6.80 (95% CI 3.26-14.18)] than S+MwA- subjects. Significant atherosclerosis was not detected in S+MwA+ patients. Compared to S-MwA+, S+MwA+ patients were characterized by visual [OR 3.82 (95% CI 1.36-10.66)] and shorter-lasting (20.0 min IQr 13.1 vs 30.0 min IQr 25.0; p < 0.001) aura, and PFO [OR 1.26 (95% CI 1.03-1.54)]. Regression analysis evidenced that only shorter aura duration associated with stroke (p = 0.001). High-risk PFO was equally represented in S+MwA-, S+MwA+, S-MwA+ groups.
Conclusions:
Shorter visual aura and CIS characterize MwA patients with stroke. Although more prevalent, PFO can not be considered the main responsible for the increased stroke risk in MwA patients but as a part of a complex multifactorial condition.
Insights
Migraine with Aura (MwA) patients experiencing acute cerebral ischemia often have shorter visual auras and cryptogenic ischemic strokes (CIS). Patent foramen ovale (PFO) is more common but not the sole cause of stroke risk in these patients.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroscience
Background:
- Migraine with Aura (MwA) is a neurological condition that can be associated with an increased risk of stroke.
- Understanding the specific clinical and aura characteristics of MwA patients who experience acute cerebral ischemia is crucial for risk stratification and management.
Purpose of the Study:
- To delineate the clinical profile and aura characteristics of patients with Migraine with Aura (MwA) who suffer acute cerebral ischemia.
- To compare stroke phenotypes and risk factors in stroke patients with and without MwA, and to analyze aura features in MwA patients with and without stroke.
Main Methods:
- A retrospective, multicenter case-control study was conducted.
- Stroke phenotypes and vascular risk factors were reviewed in patients with MwA and stroke (S+MwA+) versus those with stroke but without MwA (S+MwA-).
- Risk factors, aura type, duration, onset age, and frequency were analyzed in S+MwA+ patients and matched controls without stroke (S-MwA+), including investigation for patent foramen ovale (PFO).
Main Results:
- The study included 539 stroke patients (7.7% with MwA) and 94 patients with MwA but no stroke.
- S+MwA+ patients were younger and more frequently presented with PFO, septal interatrial aneurysm, and cryptogenic ischemic stroke (CIS) compared to S+MwA- patients. Atherosclerosis was not significant in S+MwA+.
- Compared to S-MwA+ patients, S+MwA+ patients exhibited more frequent visual auras, shorter aura duration, and a higher prevalence of PFO. Shorter aura duration was significantly associated with stroke.
Conclusions:
- Migraine with Aura patients who experience stroke are characterized by shorter visual auras and CIS.
- While PFO is more prevalent in these patients, it is considered a contributing factor within a complex multifactorial condition rather than the sole cause of increased stroke risk.
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