Late Onset of Migraine With Aura Linked to Increased Stroke Risk in Late Life

The study underscores the importance of migraine with aura symptom onset in the evaluation of ischemic stroke risk in late life.

Increased risk for ischemic stroke in late life has been reported in individuals with late onset of migraine with aura (MA), according to study results published in the journal Headache.

In this ongoing prospective longitudinal community-based cohort study, investigators sought to examine the association between cumulative exposure to migraine and the incidence of ischemic stroke. All participants were interviewed to determine migraine history at the third visit (1993 to 1995) and followed for ischemic stroke incidence over 20 years. A post hoc analysis was conducted to assess the link between age at migraine onset and ischemic stroke.

Of the 11,592 participants who were included in the study, 55.3% were women and 76.5% were white. Mean participant age was 61. Nearly 14% of the participants had a history of migraine headaches, 3.85% had a history of MA, and 9.7% had a history of migraine without aura (MO). Mean age at onset of migraine symptoms was 37.

In the study cohort, 5.95% of participants experienced an incident ischemic stroke event between the third in-person visit and 2012. Of all participants with migraine (both MA and MO), 5.46% (86 of 1575) experienced an incident ischemic stroke during this time period. The incident rate of stroke in participants with MA and age at onset ≥50 was 6.67 per 100 person-years compared with 3.04 per 100 person-years in  participants with MA onset at age <50.

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No association was reported between age at MA onset ≥50 and ischemic stroke compared with the no-headache group (adjusted hazard ratio [aHR] 2.17; 95% CI, 1.39-3.39; P <.001). Moreover, MA onset at age <50 was not associated with stroke (aHR 1.31; 95% CI, 0.86-2.02; P =.212). MO was not associated with an increased risk for stroke, regardless of age at onset of migraine. The absolute risk for stroke was 8.27% (37 of 447) in participants with MA and 4.25% (48/1128) in  participants with MO.

A major study limitation was the fact that since migraine classification was based on questionnaires administered in late midlife and thus subject to recall bias, it was possible that the participants may have recalled more recent migraines better than they recalled older migraines.

The investigators concluded that the results of this study highlight the importance of the age of onset of MA when evaluating risk for stroke among older migraineurs. Future prospective studies are warranted, in order to explore the link between cumulative exposure to migraine and incidence of ischemic stroke.

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Androulakis XM, Sen S, Kodumuri N, et al. Migraine age of onset and association with ischemic stroke in late life: 20 years follow-up in ARIC [published online January 21, 2019]. Headache. doi:10.1111/head.13468

This article originally appeared on Neurology Advisor