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

  • Image Result

    Selection process for study inclusion in the meta-analysis.

    Selection process for study inclusion in the meta-analysis.

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    (A) Methodological quality summary for 14 case-control studies. Colors in table correspond to reviewers' consensus answers to questions at the top of the figure for each study, with green indciating “

    (A) Methodological quality summary for 14 case-control studies. Colors in table correspond to reviewers' consensus answers to questions at the top of the figure for each study, with green indciating “yes,” yellow indicating “uncertain,” and red indicating “no.” (B) Methodological quality summary for 8 cohort studies. Colors in table correspond to reviewers' consensus answers to questions at the top of the figure for each study, with green indicating “yes,” yellow indicating “uncertain,” and red indicating “no.” LTFU = loss to follow-up.

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    (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke

    (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke in participants with migraine with aura versus no migraine. Size of data markers indicates weight of study. (C) Adjusted effect estimates of ischemic stroke in participants with migraine without aura versus no migraine. Size of data markers indicates weight of study. (D) Adjusted effect estimates of ischemic stroke in studies of only women participants with any migraine versus no migraine. Size of data markers indicates weight of study. (E) Adjusted effect estimates of ischemic stroke in low bias studies in participants with any migraine versus no migraine. Size of data markers indicates weight of study.

  • Image Result
    (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke

    (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke in participants with migraine with aura versus no migraine. Size of data markers indicates weight of study. (C) Adjusted effect estimates of ischemic stroke in participants with migraine without aura versus no migraine. Size of data markers indicates weight of study. (D) Adjusted effect estimates of ischemic stroke in studies of only women participants with any migraine versus no migraine. Size of data markers indicates weight of study. (E) Adjusted effect estimates of ischemic stroke in low bias studies in participants with any migraine versus no migraine. Size of data markers indicates weight of study.

  • Image Result
    (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke

    (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke in participants with migraine with aura versus no migraine. Size of data markers indicates weight of study. (C) Adjusted effect estimates of ischemic stroke in participants with migraine without aura versus no migraine. Size of data markers indicates weight of study. (D) Adjusted effect estimates of ischemic stroke in studies of only women participants with any migraine versus no migraine. Size of data markers indicates weight of study. (E) Adjusted effect estimates of ischemic stroke in low bias studies in participants with any migraine versus no migraine. Size of data markers indicates weight of study.

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    Influence of removing studies one by one on adjusted effect estimates of ischemic stroke. Circles are effect estimates and horizontal dotted lines 95% confidence intervals for meta-analysis of the stu

    Influence of removing studies one by one on adjusted effect estimates of ischemic stroke. Circles are effect estimates and horizontal dotted lines 95% confidence intervals for meta-analysis of the studies listed, excluding the study indicated by the circle. The vertical line in the center is the summary effect estimate including all listed studies.

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    Funnel plot of studies reporting adjusted odds ratios. Plots are log standard error of effect estimate by adjusted effect estimate, centered on the pooled adjusted effect estimate. The pseudo 95% conf

    Funnel plot of studies reporting adjusted odds ratios. Plots are log standard error of effect estimate by adjusted effect estimate, centered on the pooled adjusted effect estimate. The pseudo 95% confidence interval corresponds to the expected 95% confidence interval for a given standard error. OR = odds ratio.

 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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