Migraine and Stroke Risk

Patient Expert

What Did the Studies Show?

Those of you who have followed my work are bound to have seen me warn that Migraine disease, especially with prolonged Migraine attacks, increases our risk of stroke. MAGNUM, the National Migraine Association, has taken this position for several years as well. Our position was based on studies that were quite legitimate, but not very well known, as well as unfortunate anecdotal evidence from Migraineurs who had experienced Migrainous strokes and turned to us for education and support.

An interesting paper has been published that pulls together data from 14 studies, correlating and analyzing the data to offer a more conclusive overall picture. "Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies" uses data from studies conducted between 1966 and June of 2004, that examined the association between migraine and risk of ischemic stroke.

The results of their analysis:

  • The averaged risk of stroke for all Migraineurs was 2.16 times that of people without Migraine.
  • Migraineurs who experience Migraine with aura had 2.27 times the risk factor of that of non-Migraineurs.
  • Migraineurs who experience Migraine without aura had 1.83 times the risk factor of that of non-Migraineurs.
  • Adding oral contraceptives resulted in increasing the risk of stroke by approximately eight times.

What do the results mean? The mainstream press got some great headlines out of this:

  • "Double" trouble for Migraine Sufferers and Stroke risk
  • Stroke risk doubles for migraine sufferers
  • Migraines linked to doubling of stroke risk
  • Migraine Sufferers Are More Susceptible to Strokes; Oral Contraceptives Worsen the Condition

Etminan et al say the results "strongly suggest that Migraine may be an independent risk factor for stroke."1 Their review and interpretation of the 14 studies gives an interpretation to the data that warrants indicates a need for future study into the link between Migraine disease and stroke, the mechanism of Migraine-related stroke, and the increased risk presented by oral contraceptives.

Dr. Anne MacGregor, director of clinical research at the City of London Migraine Clinic and acting general secretary of the International Headache Society (IHS), commented, "There is no doubt that there is a relationship between migraine and stroke, and that the risk is greater with aura migraines and women on the pill. That is indisputable... We do not want people with migraine to think they are at high risk of having a stroke... The absolute numbers are very small. You are far more likely to get a stroke from smoking. That's the big risk factor."2

To put all of this into better perspective, I went to Dr. Fred Sheftell, founder and director of the New England Center for Headache in Stamford, Connecticut, and a well known researcher and author in the field.3 He provided the statistics for those without Migraine disease and compared them to those for Migraineurs:

  • "The average stroke prevalence in women in the general population is 9 per 100,000, which represents absolute risk.
  • If patients with migraine have an average of 2.16 times greater risk that's about 20 per 100,000, still a very low absolute risk.
  • On oral contraceptives, the absolute risk is about 75 per 100,000.
  • Of course the greatest risk factor is smoking!!"

What this study does not indicate is that Migraineurs should panic. As with any disease, we need to know any risks Migraine presents so we are prepared and can do our part to take care of ourselves and try to avoid complications.

When to seek immediate care:

  • As we've said before, if you have the worst headache or Migraine of your life, call your doctor or go to the emergency room. Extreme head pain can be a symptom of a stroke. Even though she was suffering from an aneurysm, Sharon Stone said it best, "If you have the worst headache you've ever had, go to the hospital because by the time you get to the hospital, you're as far gone as you wanna be."
  • If you experience numbness or paralysis that you have not experienced with a Migraine before, call your doctor or go to the emergency room.
  • If you lose consciousness during a Migraine, it hasn't happened to you during previous Migraines, and you haven't discussed it with your doctor, call your doctor or go to the emergency room.
  • If you have a severe, unremitting Migraine for more than 72 hours, it is Status Migrainous, and you should call your doctor or go to the emergency room.
  • Obviously, it's impossible to predict all circumstances under which we might need to call our doctor or go to the emergency room. If your Migraine seems out of control and frightening, it's better to get it checked out and be safe.

Other than emergencies, remember to consult your doctor whenever your Migraine patterns change. Since the symptoms exhibited by Migraine attacks can also be the symptoms of other conditions, it's important to check with our doctors to be sure they are actually Migraine symptoms.

Now is the time to talk to your doctor about risk factors for stroke. Find out what risk factors you have and what lifestyle modifications you can make to help prevent strokes. You can also find helpful information about stroke prevention at the web site of the American Stroke Association. Education is a vital part of our medical care. Therefore, we need to know about the increased stroke risk associated with Migraine. Now that we do, rather than letting it make us fearful, let's use it to motivate us to evaluate our lifestyles. Are they as healthy as they should be? How can we modify our lifestyles to reduce the risk of stroke, heart disease, diabetes, and other diseases? Let's take this opportunity to make our lives better. Lifestyle changes aren't easy, but they can be very beneficial to say the least. One way to make them easier and to make it more likely that we'll stick with difficult changes is to discuss the changes with others who are making similar changes. If you'd like to have such a discussion, our forum is an excellent place to find people who understand and are in similar situations. We may have Migraine disease, but let's work to control it rather than letting it control us.


Resources:

1 Etminan, Mahar; Takkouche, Bahi; Isorna, Francisco Caamaño; Samii, Ali. "Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies." BMJ, doi:10.1136/bmj.38302.504063.8F. December 13, 2004.

2 "Migraines 'double' risk of stroke." BBC News UK Edition. December 13, 2004.

3 Interview with Dr. Fred Sheftell. December, 2004.