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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Article info
Publication history
Published online: May 20, 2010
Footnotes
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.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Is Migraine a Modifiable Risk Factor for Ischemic Stroke? Potentially NotThe American Journal of MedicineVol. 124Issue 8
- PreviewNumerous 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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