Association Between Migraine With and Without Aura and Cervical Artery Dissection

Research suggests that migraine without aura (MwoA) is a risk factor for cervical artery dissection (CeAD); however, the association between migraine with aura (MwA) and CeAD remains inconclusive. We tested the coprimary hypotheses of positive associations between both MwA and MwoA and CeAD within two years following migraine diagnosis, compared to matched non-migraine controls, as measured by risk ratio (RR).

We queried de-identified US medical records data (TriNetX, LLC, Cambridge, Massachusetts, United States) spanning the years 2014-2024 to identify three cohorts of patients without previous CeAD. These included (1) individuals with a new diagnosis of MwA, (2) individuals with a new diagnosis of MwoA, and (3) non-migraine controls. Controlling for confounders, we created two 1:1 propensity-matched cohort pairs, having 217,390 patients (MwA versus controls) and 277,865 patients (MwoA versus controls).

Compared to non-migraine controls, patients with either MwA or MwoA had an increased incidence and risk of CeAD: MwA (95% CI) (0.095% vs. 0.016%; RR=5.91 (4.13,8.46); p<0.0001) and MwoA (0.058% vs. 0.016%; RR=3.60 (2.59,5.01); p<0.0001).

Incidence and risk of vertebral and carotid artery dissections were similarly increased for both MwA and MwoA. Further research is needed to examine the pathophysiological mechanisms underlying the migraine-CeAD association, potential mediating factors, and temporal association between migraine attacks and CeAD.