Migraine in Young Stroke Patients-Better Outcomes Despite Distinct Risk Profiles: Insights From the STROKE-CARD-Study

Migraine is a common neurological disorder and a non-traditional risk factor for ischaemic stroke. Its relationship with specific stroke subtypes and post-stroke outcomes remains unclear. We evaluated the association between migraine (with and without aura), stroke aetiology, functional outcomes, and cardiovascular risk profiles in young patients with ischaemic stroke or TIA.

Patients aged ≤ 55 years enrolled in the STROKE-CARD long-term follow-up study underwent structured face-to-face headache interviews by headache specialists using ICHD-3 criteria. A predefined protocol collected demographic, clinical, neuroimaging, aetiological, and cardiovascular risk data.

Among 289 young stroke patients (median age 48.0 [41-52] years; 36.3% women), 92 (31.8%) had a history of migraine (51.1% with aura). Migraine was more common in women, associated with younger age at stroke onset and more frequent headache at stroke onset, but not with traditional vascular risk factors. PFO was more prevalent in patients with migraine with aura (68.9% vs. 36.9% no migraine, p < 0.001). No significant differences were observed in stroke territory or stroke pattern. Stroke severity (NIHSS) and functional outcome (mRS) at discharge were more favourable in migraineurs (p ≤ 0.001). In multivariable analysis, migraine without aura was independently associated with good functional outcome (OR 7.21, 95% CI 1.93-26.93, p = 0.003).

In young adults with ischaemic stroke, migraine-particularly with aura-was associated with younger age at stroke onset and a higher prevalence of PFO, while traditional vascular risk factors and stroke characteristics were similar across groups. Despite comparable stroke patterns, patients with migraine experienced more favourable short-term outcomes.

Post-Stroke Disease Management-Stroke Card: NCT02156778; Stroke Card Long-term Follow-Up NCT04205006.