The American Journal of Medicine
Volume 123, Issue 7 , Pages 612-624, July 2010

Migraine Headache and Ischemic Stroke Risk: An Updated Meta-analysis

  • June T. Spector, MD, MPH

      Affiliations

    • Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
    • ,
  • Susan R. Kahn, MD, MSc

      Affiliations

    • Department of Medicine, McGill University Division of Internal Medicine, and Center for Clinical Epidemiology & Community Studies, Jewish General Hospital, Montreal, QC, Canada
    • ,
  • Miranda R. Jones, BA

      Affiliations

    • Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
    • ,
  • Monisha Jayakumar, BDS, MPH

      Affiliations

    • Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
    • ,
  • Deepan Dalal, MBBS, MPH

      Affiliations

    • Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
    • ,
  • Saman Nazarian, MD

      Affiliations

    • Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
    • Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md
    • Corresponding Author InformationRequests for reprints should be addressed to Saman Nazarian, MD, Division of Cardiac Arrhythmia, Johns Hopkins Hospital, Carnegie 592C, 600 N. Wolfe Street, Baltimore, MD 21287

published online 20 May 2010.

Abstract 

Background

Observational studies, including recent large cohort studies that were unavailable for prior meta-analysis, have suggested an association between migraine headache and ischemic stroke. We performed an updated meta-analysis to quantitatively summarize the strength of association between migraine and ischemic stroke risk.

Methods

We systematically searched electronic databases, including MEDLINE and EMBASE, through February 2009 for studies of human subjects in the English language. Study selection using a priori selection criteria, data extraction, and assessment of study quality were conducted independently by reviewer pairs using standardized forms.

Results

Twenty-one (60%) of 35 studies met the selection criteria, for a total of 622,381 participants (13 case-control, 8 cohort studies) included in the meta-analysis. The pooled adjusted odds ratio of ischemic stroke comparing migraineurs with nonmigraineurs using a random effects model was 2.30 (95% confidence interval [CI], 1.91-2.76). The pooled adjusted effect estimates for studies that reported relative risks and hazard ratios, respectively, were 2.41 (95% CI, 1.81-3.20) and 1.52 (95% CI, 0.99-2.35). The overall pooled effect estimate was 2.04 (95% CI, 1.72-2.43). Results were robust to sensitivity analyses excluding lower quality studies.

Conclusions

Migraine is associated with increased ischemic stroke risk. These findings underscore the importance of identifying high-risk migraineurs with other modifiable stroke risk factors. Future studies of the effect of migraine treatment and modifiable risk factor reduction on stroke risk in migraineurs are warranted.

Keywords: Cerebral ischemia, Epidemiology, Meta-analysis, Risk factors, Stroke

 

 Funding: Dr. Kahn is a recipient of a National Career Scientist Award from the Fonds de la Recherche en Santé du Québec. Dr. Nazarian is funded by the Johns Hopkins Richard S. Ross Clinician Scientist Award, the PJ Schafer Memorial Research Award, and the National Institutes of Health Clinical Research Scholars Program (1KL2RR025006-01). We did not receive any additional funding, including pharmaceutical industry funds, for the preparation of this manuscript or any related research.

 Conflict of Interest: All authors report no conflicts of interest.

 Authorship: All authors had access to the data and a role in writing the manuscript.

PII: S0002-9343(10)00129-4

doi:10.1016/j.amjmed.2009.12.021

The American Journal of Medicine
Volume 123, Issue 7 , Pages 612-624, July 2010

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