Introducing a risk score for predicting ischemic stroke in migraine with or without visual aura

Area of Science:

• Neurology
• Cardiovascular Medicine
• Epidemiology

Background:

• Migraine with aura is a known risk factor for ischemic stroke.
• Assessing stroke risk in migraineurs requires a tool that incorporates specific migraine-related factors alongside traditional vascular risk factors.

Purpose of the Study:

• To develop and validate the Migraine Associated Risk of Stroke score (MARS+) for predicting ischemic stroke risk in individuals with a history of migraine.
• To integrate vascular risk factors, migraine characteristics, and medication use into a comprehensive stroke risk assessment tool for migraineurs.

Main Methods:

• Prospective evaluation of participants from the Atherosclerosis Risk in Communities (ARIC) Cohort with a history of migraine.
• Utilized Cox proportional hazards models to identify significant risk factors for ischemic stroke.
• Developed the MARS+ score by assigning weighted points to significant risk factors, including age, race, hypertension, diabetes, BMI, atrial fibrillation, and specific migraine characteristics and medications.

Main Results:

• The MARS+ score incorporates factors such as aura presence, migraine duration, steroid use, and SSRI use.
• A MARS+ score of 5 or higher was identified as a threshold for high lifetime risk of ischemic stroke.
• MARS+ ≥5 was associated with a hazard ratio of 4.09 for ischemic stroke (95% CI: 2.67-6.26) in 1485 migraineurs, of whom 112 experienced a stroke.

Conclusions:

• The MARS+ score effectively predicts ischemic stroke risk in middle-aged individuals with migraine.
• This score offers enhanced generalizability by including migraine-specific factors and medication use, which may contribute to increased stroke risk.