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TOPLINE:

Migraine with aura is associated with a higher risk for ischemic stroke in middle-aged and older adults, new research showed. The risk was particularly high among men younger than 72 years, regardless of aura status, whereas migraine without aura was not associated with stroke risk.

METHODOLOGY:

• Researchers analyzed data from 11,381 Black and White adults without stroke (mean age, 72.1 years; 55.2% women; 34.8% Black individuals) enrolled in the REGARDS cohort study in the US.
• Migraine history and aura status were determined through self-report physician diagnosis and visual symptoms before headache onset.
• Of the participants, 1130 reported migraine, including 491 with aura and 639 without aura. Participants were followed for a mean of 6.4 years for ischemic stroke.
• Outcome measures included ischemic stroke, adjudicated by two stroke experts; analysis was adjusted for age, race, sex, socioeconomic factors, and stroke risk factors.

TAKEAWAY:

• Ischemic stroke was observed in 3.9% of participants with migraine and 3.4% of those without migraine. Stroke occurred in 4.7% of participants with migraine with aura and 3.3% of those with migraine without aura.
• Migraine overall was not significantly associated with ischemic stroke risk (adjusted hazard ratio [aHR], 1.35; 95% CI, 0.98-1.87).
• Participants with migraine with aura had a 73% increased risk for ischemic stroke compared with those without migraine (aHR, 1.73; 95% CI, 1.12-2.65). Migraine without aura was not associated with stroke risk (aHR, 1.10; 95% CI, 0.70-1.72).
• Men younger than 72 years with migraine, regardless of aura status, had the highest risk for ischemic stroke (aHR, 3.67; 95% CI, 1.96-6.88). No increased risk was observed in women or men aged 72 years or older.
• No significant interactions were noted for migraine-by-race, migraine-by-age, or migraine-by-sex.

IN PRACTICE:

“Our result that middle-aged and older male participants under age 72 had a much higher risk of stroke was unexpected since previous research in young people has shown that stroke disproportionately affects female individuals,” lead investigator Adam Sprouse Blum, MD, PhD, University of Vermont, Burlington, Vermont, said in a press release.

“Future studies are needed to better understand these findings. Should the findings be confirmed, it may be necessary to provide targeted stroke prevention counseling for individuals in this age group,” Sprouse Blum added.

SOURCE:

The study was led by Sprouse Blum. The study was published online on May 20 in Neurology Open Access.

LIMITATIONS:

Migraine classification relied on participants’ recall of clinician diagnosis and self-reported aura symptoms, which may have led to an underdiagnosis and misclassification. The study did not access age at migraine diagnosis and could not distinguish between recent and remote migraine history. There was a lack of data on potential confounders such as migraine frequency or severity, healthcare utilization, alcohol use, and hormone replacement therapy. Information on stroke subtype was unavailable in about half of the cases.

DISCLOSURES:

The study was funded by the Cardiovascular Research Institute at the University of Vermont. REGARDS was co-funded by the National Institute of Neurologic Disorders and Stroke and the National Institute on Aging of the National Institutes of Health. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.