Association Between Migraine and Ischemic Stroke Caused by Cervical Artery Dissection

A study published in JAMA Neurology found a consistent association between migraine and ischemic stroke caused by cervical artery dissection (CEAD IS).¹

Up to 20% of strokes in young adults are caused by CEAD, which is the leading cause of stroke in this population.² However, few studies have shed light on the mechanisms driving this link, and it is unclear how certain factors may influence disease risk. Migraine, for example, has been shown to be more prevalent among patients with than without CEAD IS, and some findings suggest that this connection may be stronger for migraine with aura vs migraine without aura.^3,4 

In the current research, the sample of 2485 patients aged 18 to 45 years (46.8% women) was part of the Italian Project on Stroke at Young Age, a large registry of patients with early-onset ischemic IS. The registry includes data on patients from neurologic centers in 26 hospitals. The authors investigated potential differences in migraine frequency and subtypes between patients with CEAD IS and non-CEAD IS. In addition to these main outcome measures, they examined characteristics of CEAD IS patients with and without migraine.

The findings revealed that 13.4% of patients had CEAD IS, while 86.6% had non-CEAD IS. The CEAD IS group had higher rates of migraine than the non-CEAD IS group (30.8% vs 24.4%, P =.01). This difference was mainly accounted for by migraine without aura (24.0% vs 15.6%, P <.001), which was found to be independently associated with CEAD IS (odds ratio [OR]: 1.74; 95% CI, 1.30-2.33).

This association was stronger among male patients (OR: 1.99; 95% CI, 1.31-3.04) and those younger than 39 years (OR: 1.82; 95% CI, 1.22-2.71). In addition, CEAD IS patients with and without migraines had similar risk profiles in terms of factors such as hypertension and diabetes (19.4% vs 24.7%, P =.29; and 1.0% vs 1.3%, P >.99, respectively).

“Our data support consideration of a history of migraine as a marker for increased risk of IS caused by CEAD, as well as a putative susceptibility factor for CEAD, regardless of its clinical features,” the investigators wrote. Potential mechanisms underlying this link include shared genetic susceptibility and endothelial dysfunction. The results underscore the “need for further analyses to investigate the nature and mechanisms of elevated risk in migraineurs and to elucidate whether this risk applies to only specific subsets of patients with migraine.”

Summary and Clinical Applicability

The current research found elevated rates of migraine in patients with CEAD IS compared with those with non-CEAD IS. This finding was particularly notable for migraine without aura.

Limitations

Interpretation of the results could be limited by the study’s hospital setting, which could lead to hospital referral selection bias. There was also no assessment of migraine frequency, severity, or other variables that would allow for consideration of different migraine patterns. 

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References

1. De Giuli V, Grassi M, Lodigiani C, et al. Association between migraine and cervical artery dissection: the Italian project on stroke in young adults [published online March 6, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2016.5704
2. Blum CA, Yaghi S. Cervical artery dissection: a review of the epidemiology, pathophysiology, treatment, and outcome. Arch Neurosci. 2015; 2(4):e26670. doi: 10.5812/archneurosci.26670
3. Rist PM, Diener HC, Kurth T, Schürks M. Migraine, migraine aura, and cervical artery dissection: a systematic review and meta-analysis. Cephalalgia. 2011;31(8):886-896. doi: 10.1177/0333102411401634
4. Metso TM, Tatlisumak T, Debette S, et al; CADISP group. Migraine in cervical artery dissection and ischemic stroke patients. Neurology. 2012;78(16):1221-1228. doi: 10.1212/WNL.0b013e318251595f