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First Type Migraine Plus Frequency Influence Ischaemic Stroke Risk In Women

Women whose first migraines are accompanied with aura have a significantly increased risk of ischaemic stroke, and this is even higher if the initial migraine with aura occurs more than 12 times a year.

This finding is based on further analysis of a study by Dr Michael Donaghy, Department of Clinical Neurology, Radcliffe Infirmary, Oxford, England, and fellow members of the World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.

The initial WHO investigation focused on steroid hormone contraceptive use and cardiovascular disease. Researchers have further analyzed data on a subsumable of women from five European countries collaborating in the multi centre, case-control study, and which indicated a relation between migraine and stroke.

Researchers point out that women of childbearing age with migraine appear to be at higher risk of ischaemic stroke than non-migraineurs. This risk appears even higher than that from other factors, including hypertension, smoking, and oral contraception.

Data in the present analysis included the nature and frequency of past and current headaches, including any accompanying aura, family history of migraine, changes in the frequency and characteristics of headache associated with use of oral contraceptives, and whether headache with migrainous features had occurred within three days prior to stroke. The International Headache Society's criteria was used to define migraine.

They evaluated 86 women admitted to hospital with a first time ischaemic stroke with 214 women admitted to hospital for other illness. The women were between 20 and 44 years old.

Compared with the other women, the risk of ischaemic stroke increased by a factor of 8 among those whose first ever migraines were accompanied by aura, and by a factor of 10 among those whose first migraines with aura occurred more than once a month. Stroke risk was four times higher in those whose migraine attacks had gone on for more than 12 years.

There was no evidence that oral contraceptives specifically influenced the particular risks associated with the initial type and frequency of migraine. "It remains unknown whether, despite conventional medical opinion, migraine with aura has a different biological basis to migraine without aura," the researchers declared. "Furthermore, it is not established whether factors which might convert an individual's migraine type from without aura to with aura produce an increased risk of stroke."

The researchers conclude that "considered overall, these data suggest that the biological determinants of initial migraine type may be as important in determining risk of an ischaemic stroke as any change in migraine type induced by oral contraception."
Journal of Neurology, Neurosurgery & Psychiatry 2002;73:747-50. "Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age."

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