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

References 

  1. Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–1757
  2. Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2:43–53
  3. Stewart WF, Shechter A, Rasmussen BK. Migraine prevalence (A review of population-based studies). Neurology. 1994;44:S17–S23
  4. Lipton RB, Bigal ME, Diamond M, et al. AMPP Advisory Group Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68:343–349
  5. Goldstein LB, Adams R, Alberts MJ, et al. American Heart Association/American Stroke Association Stroke Council; Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; Quality of Care and Outcomes Research Interdisciplinary Working Group; American Academy of Neurology Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37:1583–1633
  6. Curtis KM, Mohllajee AP, Peterson HB. Use of combined oral contraceptives among women with migraine and nonmigrainous headaches: a systematic review. Contraception. 2006;73:189–194
  7. Etminan M, Takkouche B, Isorna FC, Samii A. Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. BMJ. 2005;330:63
  8. Lloyd-Jones D, Adams R, Carnethon M, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21–e181
  9. Hall GC, Brown MM, Mo J, MacRae KD. Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice. Neurology. 2004;62:563–568
  10. Kurth T, Slomke MA, Kase CS, et al. Migraine, headache, and the risk of stroke in women: a prospective study. Neurology. 2005;64:1020–1026
  11. Kurth T, Gaziano JM, Cook NR, et al. Migraine and risk of cardiovascular disease in men. Arch Intern Med. 2007;167:795–801
  12. Becker C, Brobert GP, Almqvist PM, et al. Migraine and the risk of stroke, TIA, or death in the UK (CME). Headache. 2007;47:1374–1384
  13. GS Higgins JPT. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 www.cochrane-handbook.orgAccessed March 5, 2009
  14. Pavlakis SG, Phillips PC, DiMauro S, et al. Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes: a distinctive clinical syndrome. Ann Neurol. 1984;16:481–488
  15. Dichgans M, Mayer M, Uttner I, et al. The phenotypic spectrum of CADASIL: clinical findings in 102 cases. Ann Neurol. 1998;44:731–739
  16. Marini C, Carolei A, Roberts RS, et al. Focal cerebral ischemia in young adults: a collaborative case-control study. Neuroepidemiology. 1993;12:70–81
  17. Schwaag S, Nabavi DG, Frese A, et al. The association between migraine and juvenile stroke: a case-control study. Headache. 2003;43:90–95
  18. MacClellan LR, Giles W, Cole J, et al. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke. 2007;38:2438–2445
  19. Naess H, Nyland HI, Thomassen L, et al. Etiology of and risk factors for cerebral infarction in young adults in western Norway: a population-based case-control study. Eur J Neurol. 2004;11:25–30
  20. Lidegaard O, Kreiner S. Contraceptives and cerebral thrombosis: a five-year national case-control study. Contraception. 2002;65:197–205
  21. Stang PE, Carson AP, Rose KM, et al. Headache, cerebrovascular symptoms, and stroke: the Atherosclerosis Risk in Communities Study. Neurology. 2005;64:1573–1577
  22. Velentgas P, Cole JA, Mo J, et al. Severe vascular events in migraine patients. Headache. 2004;44:642–651
  23. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting (Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group). JAMA. 2000;283:2008–2012
  24. Hayden JA, Cote P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144:427–437
  25. von Elm E, Altman DG, Egger M, et al. STROBE Initiative (The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies). Ann Intern Med. 2007;147:573–577
  26. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(Suppl 1):9–160
  27. Special report from the National Institute of Neurological Disorders and Stroke (Classification of cerebrovascular diseases III). Stroke. 1990;21:637–676
  28. Kidwell CS, Warach S. Acute ischemic cerebrovascular syndrome: diagnostic criteria. Stroke. 2003;34:2995–2998
  29. Collaborative Group. Oral contraceptives and stroke in young women (Associated risk factors). JAMA. 1975;231:718–722
  30. Buring JE, Hebert P, Romero J, et al. Migraine and subsequent risk of stroke in the Physicians' Health Study. Arch Neurol. 1995;52:129–134
  31. Carolei A, Marini C, De Matteis G. History of migraine and risk of cerebral ischaemia in young adults (The Italian National Research Council Study Group on Stroke in the Young). Lancet. 1996;347:1503–1506
  32. Chang CL, Donaghy M, Poulter N. Migraine and stroke in young women: case-control study (The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception). BMJ. 1999;318:13–18
  33. Donaghy M, Chang CL, Poulter N European Collaborators of The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age. J Neurol Neurosurg Psychiatr. 2002;73:747–750
  34. Haapaniemi H, Hillbom M, Juvela S. Lifestyle-associated risk factors for acute brain infarction among persons of working age. Stroke. 1997;28:26–30
  35. Henrich JB, Horwitz RI. A controlled study of ischemic stroke risk in migraine patients. J Clin Epidemiol. 1989;42:773–780
  36. Merikangas KR, Fenton BT, Cheng SH, et al. Association between migraine and stroke in a large-scale epidemiological study of the United States. Arch Neurol. 1997;54:362–368
  37. Lidegaard O. Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease. Br J Obstet Gynaecol. 1995;102:153–159
  38. Nightingale AL, Farmer RD. Ischemic stroke in young women: a nested case-control study using the UK General Practice Research Database. Stroke. 2004;35:1574–1578
  39. Tzourio C, Iglesias S, Hubert J, et al. Migraine and risk of ischaemic stroke: a case control study. BMJ. 1993;307:289–292
  40. Tzourio C, Tehindrazanarivelo A, Iglesias S, et al. Case-control study of migraine and risk of ischaemic stroke in young women. BMJ. 1995;310:830–833
  41. Mosek A, Marom R, Korczyn AD, Bornstein N. A history of migraine is not a risk factor to develop an ischemic stroke in the elderly. Headache. 2001;41:399–401
  42. Elliott D. Migraine and stroke: current perspectives. Neurol Res. 2008;30:801–812
  43. D'Andrea G, Hasselmark L, Alecci M, et al. Platelet secretion from dense and alpha-granules in vitro in migraine with or without aura. J Neurol Neurosurg Psychiatry. 1994;57:557–561
  44. Zeller JA, Frahm K, Baron R, et al. Platelet-leukocyte interaction and platelet activation in migraine: a link to ischemic stroke?. J Neurol Neurosurg Psychiatry. 2004;75:984–987
  45. Gallai V, Sarchielli P, Firenze C, et al. Endothelin 1 in migraine and tension-type headache. Acta Neurol Scand. 1994;89:47–55
  46. Tietjen GE, Al-Qasmi MM, Athanas K, et al. Increased von Willebrand factor in migraine. Neurology. 2001;57:334–336
  47. Hering-Hanit R, Friedman Z, Schlesinger I, Ellis M. Evidence for activation of the coagulation system in migraine with aura. Cephalalgia. 2001;21:137–139
  48. Scher AI, Terwindt GM, Verschuren WM, et al. Migraine and MTHFR C677T genotype in a population-based sample. Ann Neurol. 2006;59:372–375
  49. Tanasescu R, Nicolau A, Caraiola S, et al. Antiphospholipid antibodies and migraine: a retrospective study of 428 patients with inflammatory connective tissue diseases. Rom J Intern Med. 2007;45:355–363
  50. Lechat P, Mas JL, Lascault G, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318:1148–1152
  51. Katsarava Z, Rabe K, Diener HC. From migraine to stroke. Intern Emerg Med. 2008;3(Suppl 1):S9–S16
  52. Feske SK. Stroke in pregnancy. Semin Neurol. 2007;27:442–452
  53. Allais G, Gabellari IC, Mana O, et al. Migraine and stroke: the role of oral contraceptives. Neurol Sci. 2008;29:S12–S14
  54. Sare GM, Gray LJ, Bath PM. Association between hormone replacement therapy and subsequent arterial and venous vascular events: a meta-analysis. Eur Heart J. 2008;29:2031–2041
  55. Davis PH. Use of oral contraceptives and postmenopausal hormone replacement: evidence on risk of stroke. Curr Treat Options Neurol. 2008;10:468–474
  56. Nappi RE, Sances G, Detaddei S, et al. Hormonal management of migraine at menopause. Menopause Int. 2009;15:82–86
  57. Lay CL, Payne R. Recognition and treatment of menstrual migraine. Neurologist. 2007;13:197–204
  58. Pryse-Phillips WE, Dodick DW, Edmeads JG, et al. Guidelines for the diagnosis and management of migraine in clinical practice (Canadian headache society). CMAJ. 1997;156:1273–1287

 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