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

      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

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      Linked Article

      • Is Migraine a Modifiable Risk Factor for Ischemic Stroke? Potentially Not
        The American Journal of MedicineVol. 124Issue 8
        • Preview
          Numerous studies have demonstrated an increased risk of ischemic stroke in subjects suffering from migraine and, consequently, migraine can be included among the well-documented risk factors for ischemic stroke.1,2 The meta-analysis by Spector et al3 is particularly welcome because it provides, in a rigorous way and considering the most recent papers, data referring to the magnitude of the association. However, we advise caution when assuming, as the authors do in their Introduction and Conclusion, that migraine represents a potentially modifiable risk factor for stroke.
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