More Research Links Migraine With Aura and Stroke in Women

Patient Expert

by Teri Robert, MyMigraineConnection Lead Expert

In the last few years, studies have been released about Migraine and stroke risk, and Migraine and cardiovascular disease in both women and men. To all of this information, we can now add information from the Stroke Prevention in Young Women Study.

What we know...

  • Migraine and stroke have some common risk factors including hypertension and patent foramen ovale (PFO).
  • Migraine and stroke can both have hereditary factors.
  • Migraine is considered a risk factor for ischemic stroke.

The study data that has given us this information has come from large studies that were looking at broader issues, not specifically at the relationship between Migraine disease and stroke. Thus, some questions remain.

What we don't know...

  • If the increased risk of stroke that Migraine presents applies equally to all types of Migraine, i.e., Migraine with aura, Migraine without aura, etc.
  • If the increased risk applies at all ages.
  • How much other risk factors such as smoking and oral contraceptives impact the risk of stroke.

The Stroke Prevention in Young Women Study

Study Background and Purpose: "Migraine with aura is associated with ischemic stroke, but few studies have investigated the clinical and anatomic features of this association. We assessed the association of probable migraine with and without visual aura with ischemic stroke within subgroups defined by stroke subtype, vascular territory, probable migraine characteristics, and other clinical features."

The study followed 386 women ages 15 to 49 years. Based on their responses to a questionnaire on headache symptoms, subjects were classified as having no migraine, probable migraine without visual aura, or probable migraine with visual aura (PMVA).

Results of the Stroke Prevention in Young Women Study

  • Women with PMVA had 1.5 greater odds of ischemic stroke.
  • The risk was highest in those with no history of hypertension, diabetes, or myocardial infarction compared to women with no migraine.
  • Women with PMVA who smoked and used oral contraceptives had 7.0-fold higher odds of stroke than women with PMVA who were nonsmokers and non-oral contraceptive users.
  • Women who had first experienced PMVA within the previous year had 6.9-fold higher adjusted odds of stroke compared to women with no history of migraine.
  • No association between probable migraine without visual aura and stroke was found.

Researchers' conclusions

"PMVA was associated with an increased risk of stroke, particularly among women without other medical conditions associated with stroke. Behavioral risk factors, specifically smoking and oral contraceptive use, markedly increased the risk of PMVA, as did recent onset of PMVA... n summary, we found an association between PMVA and ischemic stroke of undetermined cause. The association of smoking, OC use, and PMVA with ischemic stroke indicates a high-risk population for which appropriate management strategies are warranted."

Summary

The Stroke Prevention in Young Women Study provides additional validation to earlier studies showing a link between Migraine with aura and stroke in women. None of this data is cause for panic among female Migraineurs. It is, however, evidence that management of stroke risk factors and Migraine disease are quite important.

"This should not be a cause of alarm to women... But it is something to take into account and discuss with their physician... Migraine with visual symptoms should be considered a weak risk factor for stroke. You can't do anything about it, but it may influence what other prevention measures one may take2... Young women with probable migraine with visual symptoms can reduce their risk of stroke by stopping smoking and finding alternatives to the use of estrogen-containing contraceptives. 3"

Dr. Steven J. Kittner, lead researcher

professor of neurology at the University of Maryland School of Medicine

Please let this serve as a call to you to discuss your stroke risk factors and Migraine disease management with your doctors.


Resources:

1 MacClellan, Leah R., PhD; Giles, Wayne, MD; Cole, John, MD; Wozniak, Marcella, MD; Stern, Barney, MD, Mitchell, Braxton D., PhD; Kittner, Steven J., MD. "Probable Migraine With Visual Aura and Risk of Ischemic Stroke. The Stroke Prevention in Young Women Study." Stroke, 2007;38:2438-2445. DOI: 10.1161/STROKEAHA.107.488395.

2 Reinberg, Steven. "Women With Migraines at Higher Risk of Stroke." HealthDay News. August 9, 2007.

3 "Study: Women with Migraine-Induced Vision Problems at-Risk for Stroke." FoxNews.com. August 10, 2007.

Last updated August 13, 2007.