Migraine Linked to Higher Perioperative Stroke Risk
There's been significant discussion about migraine disease increasing stroke risk, especially in certain segments of the migraine population. A study1 published in the British Medical Journal in January of 2017 addressed migraine and the risk of perioperative (around the time of surgery) stroke and hospital readmission.
"To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate."1
- This was a prospective hospital registry study performed at Massachusetts General Hospital and two of their satellite campuses from January, 2007, and August, 2017.
- Researchers examined data from all patients who had surgery with general anesthesia and ventilation.
- There were 124,558 participants.
- Migraine history of participants was determined on the basis of their having a billing diagnoses of migraine.
- Medical records were reviewed for all perioperative ischemic stroke on the basis of MRI and CT reports, neurology consultation notes, and discharge summaries.
The primary outcome searched for was perioperative ischemic stroke within 30 days of surgery. The secondary outcome was readmission to the hospital within 30 days of discharge.
- Of the 124,558 participants, 10,179 (8.2%) had a migraine diagnosis:
- Migraine with aura: 1,278 (12.6%), and
- Migraine without aura: 8,901 (87.4%).
- Ischemic strokes occurred within 30 days of surgery in 771 (0.6%) of the study participants.
- Patients with migraine were at increased risk of perioperative ischemic stroke:
- The predicted absolute risk is 2.4 perioperative ischemic strokes for every 1,000 surgical patients.
- The risk increases to 3.9 for every 1,000 patients with migraine without aura.
- The risk increases to 6.3 for every 1,000 patients with migraine with aura.
- Patients with both migraine without aura and migraine with aura had a higher rate of readmission to hospital within 30 days of discharge.
Implications of study findings:
The study authors stated several implications of their findings, including:
- "Migraine, particularly migraine with aura, should be considered a marker for increased risk of ischemic stroke."
- "Given the high prevalence of migraine in the general population, the migraine-perioperative ischemic stroke association carries public health importance, and physicians should be aware of this increased perioperative risk, particularly in patients with migraine who present without traditional risk factors for stroke."
- "On the basis of the results of exploratory data analysis, we speculate that the use of high dose vasopressors during surgery as well a history of a possible right-to-left shunt may represent modifiable risk factors for perioperative ischemic stroke in patients with migraine with aura."
"In this large cohort of surgical patients, migraine was associated with an increased risk of perioperative ischemic stroke within 30 days of surgery. This risk was elevated in patients with migraine with aura, in those with a low estimated baseline risk of ischemic stroke, and in those undergoing ambulatory surgery. Migraine was also associated with a higher 30-day hospital readmission rate and higher risk of perioperative ischemic stroke after initial hospital discharge. We suggest that migraine should be included in the perioperative risk assessment."1
Study authors' speculations on cause:
The study authors speculated that increased risk of perioperative stroke in migraine patients may be due to a genetic predisposition and an increased perioperative vulnerability to cerebral ischemia (insufficient blood supply to the brain).
Study author comments:
In an interview with Reuters, Matthias Eikermann, MD, PhD, from Massachusetts General Hospital and Harvard Medical School in Boston, commented:
"Patients with migraine have a hyperexcitable brain, which increases the vulnerability to stroke during and after surgery.
When examining the electrical activity of the brain of patients with migraine, we observe a spreading depolarization which induces prolonged constriction of the blood vessels in the brain leading to decreased oxygen supply during migraine aura and stroke."2
Comments and implications for patients:
The results of this study are interesting and thought provoking. They're not, however, reason to panic. There are, however, implications for patients with migraine. We need to:
- work with our doctors to reduce our modifiable risk factors for stroke;
- be sure that all doctors we see are aware of our migraine history; and
- take extra steps to inform surgeons, anesthesiologists, and others caring for us before, during, and after surgery are aware of our migraine history.
I suggest digesting the results of this study calmly, followed by a conversation with your doctor to address any concerns it raises.
More helpful articles:
1 Timm F, Houle T, Grabitz S, et al. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ 2017;356:i6635.
2 Rapaport, Lisa. Migraines tied to increased stroke risk after surgery. Reugers. January 18, 2017.
Reviewed by David Watson, MD.
© Teri Robert, 2017.
Teri Robert is a leading patient educator and advocate in the area of migraine and other headache disorders, and has been writing for the HealthCentral migraine site since 2007. She is a co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association. She received the National Headache Foundation's Patient Partners Award for "ongoing patient education, support, and advocacy" in 2004 and a Distinguished Service Award from the American Headache Society in 2013. You can find links to Teri's work on her web site and blog and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.