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Chen HH, Lin CY, Chen SJ, Huang WY, Kuo CW, Chang ST. Intravascular laser irradiation of blood as novel migraine treatment: an observational study. Eur J Med Res 2023; 28:457. [PMID: 37876003 PMCID: PMC10598972 DOI: 10.1186/s40001-023-01438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Migraine is one of four major chronic diseases that cause disability. Decreases in regional cerebral blood flow (rCBF) occur during migraine attacks. Laser therapy is extensively employed in treating other vascular diseases; nevertheless, its effectiveness in migraine management remains largely unknown. Therefore, we evaluated the effect of low-level intravascular laser irradiation of blood (ILIB) therapy in patients with migraine. METHODS We performed an observational case-control study in 24 patients suffering from migraine. Patients were divided into an ILIB treatment group and a traditional rehabilitation group. This study performed clinical assessments and single-photon emission computed tomography (SPECT) prior to and after the treatment and 1 month later. Changes in rCBF-SPECT between groups and between timepoints were compared to clinical outcomes. RESULTS Nine patients undergoing rehabilitation and fifteen patients undergoing ILIB were studied from baseline to 1 month follow-up. The ILIB group, visual analog scale for pain (P = 0.001), Montreal Cognitive Assessment (P = 0.003), and Athens Insomnia Scale (P < 0.001) symptom scores significantly improved after treatment. SPECT imaging showed a 1.27 ± 0.27 fold increase in rCBF after ILIB treatment, and no significant differences in the rehabilitation group. CONCLUSIONS Low-level ILIB therapy is associated with better clinical and vascular outcomes, and may be a feasible treatment option for migraine. Although our sample size was small, our data provide a starting point for migraine laser therapy research.
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Affiliation(s)
- Hsin-Hung Chen
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, 813414, Taiwan
| | - Chun-Yu Lin
- College of Photonics, National Yang Ming Chiao Tung University, Tainan, 71150, Taiwan
| | - Shean-Jen Chen
- College of Photonics, National Yang Ming Chiao Tung University, Tainan, 71150, Taiwan
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu, 300092, Taiwan
| | - Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Zuoying Dist, # 386, Dazhong 1St Rd, Kaohsiung, 813414, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, 70119, Taiwan
| | - Chien-Wei Kuo
- Department of Nuclear Medicine, Pingtung Veterans General Hospital, Pingtung 900, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Zuoying Dist, # 386, Dazhong 1St Rd, Kaohsiung, 813414, Taiwan.
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, # 161, Section 6, Minquan East Road, Taipei, 114201, Taiwan.
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Pang Y, Cao T, Zhang Q, Hu H, Wang Z, Nie J, Jin M, Chen G, Zhang X. Retinal microvasculature features in patients with migraine: a systematic review and meta-analysis. Front Neurol 2023; 14:1187559. [PMID: 37780703 PMCID: PMC10540451 DOI: 10.3389/fneur.2023.1187559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Background Migraine is a central nervous system disorder involving neuronal and vascular factors. The brain has a close anatomical relationship with retinal vessels and similar regulatory processes, and the retinal vascular system is the only in vivo vessel that can be directly visualized, while optical coherence tomography angiography (OCTA) is an advanced retinal vascular imaging technique. In this study, OCTA was used to study the retinal vascular density (VD) and foveal avascular zone (FAZ) in migraine patients, which provided a theoretical basis for its use as a candidate for rapid and non-invasive diagnosis of migraine. Methods Published studies comparing retinal microvascular profiles between migraine patients and healthy controls were obtained by a comprehensive search of electronic databases. Nine studies were finally included, including 775 eyes (migraine group: 444 eyes, control group: 331 eyes). Pooled effect sizes were presented as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager software (version 5.30). Results The combined results revealed that the superficial and deep macular whole enface VD (MWEVD) (superficial VD: SMD = -0.30, P = 0.0001; deep VD: SMD = -0.61, P = 0.02), superficial foveal VD (FVD) (SMD = -0.42, P = 0.03), deep parafoveal VD (PFVD) (SMD = -0.31, P = 0.002), and peripapillary VD (PVD) (SMD = -0.49, P = 0.002) were significantly reduced in migraine patients compared with healthy people. However, there was a significant increase in the area of the FAZ in migraine patients (SMD = 0.56, P < 0.0001). Conclusion Migraine patients are prone to retinal microcirculation disorders, such as decreased blood vessel density and increased avascular area in the fovea. This provides a theoretical basis for OCTA as a candidate for rapid, non-invasive diagnosis of migraine.
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Affiliation(s)
- Yulian Pang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Ting Cao
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
- Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Qinglin Zhang
- Department of Ophthalmology, Huangshi Central Hospital, Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Haijian Hu
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Zhiruo Wang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Jiahe Nie
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Ming Jin
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Guiping Chen
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Xu Zhang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
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3
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Linstra KM, van Os HJA, Ruigrok YM, Nederkoorn PJ, van Dijk EJ, Kappelle LJ, Koudstaal PJ, Visser MC, Ferrari MD, MaassenVanDenBrink A, Terwindt GM, Wermer MJH. Sex Differences in Risk Profile, Stroke Cause and Outcome in Ischemic Stroke Patients With and Without Migraine. Front Neurosci 2021; 15:740639. [PMID: 34803586 PMCID: PMC8597840 DOI: 10.3389/fnins.2021.740639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: An increased risk of stroke in patients with migraine has been primarily found for women. The sex-dependent mechanisms underlying the migraine–stroke association, however, remain unknown. This study aims to explore these sex differences to improve our understanding of pathophysiological mechanisms behind the migraine–stroke association. Methods: We included 2,492 patients with ischemic stroke from the prospective multicenter Dutch Parelsnoer Institute Initiative study, 425 (17%) of whom had a history of migraine. Cardiovascular risk profile, stroke cause (TOAST classification), and outcome [modified Rankin scale (mRS) at 3 months] were compared with both sexes between patients with and without migraine. Results: A history of migraine was not associated with sex differences in the prevalence of conventional cardiovascular risk factors. Women with migraine had an increased risk of stroke at young age (onset < 50 years) compared with women without migraine (RR: 1.7; 95% CI: 1.3–2.3). Men with migraine tended to have more often stroke in the TOAST category other determined etiology (RR: 1.7; 95% CI: 1.0–2.7) in comparison with men without migraine, whereas this increase was not found in women with migraine. Stroke outcome was similar for women with or without migraine (mRS ≥ 3 RR 1.1; 95% CI 0.7–1.5), whereas men seemed to have a higher risk of poor outcome compared with their counterparts without migraine (mRS ≥ 3 RR: 1.5; 95% CI: 1.0–2.1). Conclusion: Our results indicate possible sex differences in the pathophysiology underlying the migraine–stroke association, which are unrelated to conventional cardiovascular risk factors. Further research in larger cohorts is needed to validate these findings.
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Affiliation(s)
- Katie M Linstra
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.,Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marieke C Visser
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
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4
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Kumar A, McCullough L. Cerebrovascular disease in women. Ther Adv Neurol Disord 2021; 14:1756286420985237. [PMID: 33552237 PMCID: PMC7844450 DOI: 10.1177/1756286420985237] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Cerebrovascular disease is a major cause of morbidity, mortality, and disability in women. The spectrum of disease differs between men and women, with women being particularly vulnerable to certain conditions, especially during specific periods of life such as pregnancy. There are several unique risk factors for cerebrovascular disease in women, and the influence of some traditional risk factors for stroke is stronger in women. Moreover, disparities persist in representation of women in clinical trials, acute intervention, and stroke outcomes. In this review, we aimed to explore the epidemiology, etiologies, and management of cerebrovascular disease in women, highlighting some of these differences and the growing need for sex-specific management guidelines and health policies.
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Affiliation(s)
- Aditya Kumar
- Department of Neurology, 6431 Fannin Street, Houston, TX 77030, USA
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5
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Øie LR, Kurth T, Gulati S, Dodick DW. Migraine and risk of stroke. J Neurol Neurosurg Psychiatry 2020; 91:593-604. [PMID: 32217787 PMCID: PMC7279194 DOI: 10.1136/jnnp-2018-318254] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
Migraine and stroke are two common and heterogeneous neurovascular disorders responsible for a significant burden for those affected and a great economic cost for the society. There is growing evidence that migraine increases the overall risk of cerebrovascular diseases. In this review, based on available literature through a PubMed search, we found that ischaemic stroke in people with migraine is strongly associated with migraine with aura, young age, female sex, use of oral contraceptives and smoking habits. The risk of transient ischaemic attack also seems to be increased in people with migraine, although this issue has not been extensively investigated. Although migraine appears to be associated with haemorrhagic stroke, the migraine aura status has a small influence on this relationship. Neuroimaging studies have revealed a higher prevalence of asymptomatic structural brain lesions in people with migraine. They are also more likely to have unfavourable vascular risk factors; however, the increased risk of stroke seems to be more apparent among people with migraine without traditional risk factors. The mechanism behind the migraine-stroke association is unknown. In light of the higher risk of stroke in people with migraine with aura, it is important to identify and modify any vascular risk factor. There is currently no direct evidence to support that a migraine prophylactic treatment can reduce future stroke in people with migraine.
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Affiliation(s)
- Lise R Øie
- Department of Neurology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway .,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Neurosurgery, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - David W Dodick
- Department of Neurology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
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6
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Chen S, Eikermann‐Haerter K. How Imaging Can Help Us Better Understand the Migraine‐Stroke Connection. Headache 2019; 60:217-228. [DOI: 10.1111/head.13664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Shih‐Pin Chen
- Division of Translational Research Department of Medical Research Taipei Veterans General Hospital Taipei Taiwan
- Department of Neurology Neurological InstituteTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine National Yang‐Ming University School of Medicine Taipei Taiwan
- Brain Research Center National Yang‐Ming University School of Medicine Taipei Taiwan
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7
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Mulder IA, Holswilder G, van Walderveen MAA, van der Schaaf IC, Bennink E, Horsch AD, Kappelle LJ, Velthuis BK, Dankbaar JW, Terwindt GM, Schonewille WJ, Visser MC, Ferrari MD, Algra A, Wermer MJH. Stroke progression and clinical outcome in ischemic stroke patients with a history of migraine. Int J Stroke 2019; 14:946-955. [DOI: 10.1177/1747493019851288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Patients with migraine might be more susceptible of spreading depolarizations, which are known to affect vascular and neuronal function and penumbra recovery after stroke. We investigated whether these patients have more severe stroke progression and less favorable outcomes after recanalization therapy. Methods We included patients from a prospective multicenter ischemic stroke cohort. Lifetime migraine history was based on the International Classification of Headache Disorders II criteria. Patients without confirmed migraine diagnosis were excluded. Patients underwent CT angiography and CT perfusion <9 h of onset and follow-up CT after three days. On admission, presence of a perfusion deficit, infarct core and penumbra volume, and blood brain barrier permeability (BBBP) were assessed. At follow-up we assessed malignant edema, hemorrhagic transformation, and final infarct volume. Outcome at three months was evaluated with the modified Rankin Scale (mRS). We calculated adjusted relative risks (aRR) or difference of means (aB) with regression analyses. Results We included 600 patients of whom 43 had migraine. There were no differences between patients with or without migraine in presence of a perfusion deficit on admission (aRR: 0.98, 95%CI: 0.77–1.25), infarct core volume (aB: -10.8, 95%CI: -27.04–5.51), penumbra volume (aB: -11.6, 95%CI: -26.52–3.38), mean blood brain barrier permeability (aB: 0.08, 95%CI: -3.11–2.96), malignant edema (0% vs. 5%), hemorrhagic transformation (aRR: 0.26, 95%CI: 0.04–1.73), final infarct volume (aB: -14.8, 95%CI: 29.9–0.2) or outcome after recanalization therapy (mRS > 2, aRR: 0.50, 95%CI: 0.21–1.22). Conclusion Elderly patients with a history of migraine do not seem to have more severe stroke progression and have similar treatment outcomes compared with patients without migraine.
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Affiliation(s)
- Inge A Mulder
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ghislaine Holswilder
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ale Algra
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marieke JH Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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8
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Pezzini A, Busto G, Zedde M, Gamba M, Zini A, Poli L, Caria F, De Giuli V, Simone AM, Pascarella R, Padovani A, Padroni M, Gasparotti R, Colagrande S, Fainardi E. Vulnerability to Infarction During Cerebral Ischemia in Migraine Sufferers. Stroke 2018; 49:573-578. [PMID: 29459398 DOI: 10.1161/strokeaha.118.020554] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/03/2018] [Accepted: 01/19/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral hyperexcitability in migraine experiencers might sensitize brain tissue to ischemia. We investigated whether a personal history of migraine is associated with vulnerability to brain ischemia in humans. METHODS Multicenter cohort study of patients with acute ischemic stroke who underwent a brain computed tomography perfusion and were scheduled to undergo reperfusion therapy. In a case-control design, we compared the proportion of subjects with no-mismatch, the volume of penumbra salvaged, as well as the final infarct size in a group of patients with migraine and a group of patients with no history of migraine. RESULTS We included 61 patients with migraine (34 [55.7%] men; mean age, 52.2±15.1 years; migraine without aura/migraine with aura, 44/17) and 61 patients with no history of migraine. The proportion of no-mismatch among migraineurs was significantly higher than among nonmigraineurs (17 [27.9%] versus 7 [11.5%]; P=0.039) and was more prominent among patients with migraine with aura (6 [35.3%]; P=0.030) while it was nonsignificantly increased in patients with migraine without aura (11 [25.0%]; P=0.114). Migraine, especially migraine with aura, was independently associated with a no-mismatch pattern (odds ratio, 2.65; 95% CI, 0.95-7.41 for migraine; odds ratio, 5.54; 95% CI, 1.28-23.99 for migraine with aura), and there was a linear decrease of the proportion of patients with migraine with aura with increasing quartiles of mismatch volumes. Patients with migraine with aura had also smaller volumes of salvaged penumbra (9.8±41.2 mL) compared with patients with migraine without aura (36.4±54.1 mL) and patients with no migraine (45.1±55.0 mL; P=0.056). Conversely, there was no difference in final infarct size among the 3 migraine subgroups (P=0.312). CONCLUSIONS Migraine is likely to increase individual vulnerability to ischemic stroke during the process of acute brain ischemia and might represent, therefore, a potential new therapeutic target against occurrence and progression of the ischemic damage.
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Affiliation(s)
- Alessandro Pezzini
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.).
| | - Giorgio Busto
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Marialuisa Zedde
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Massimo Gamba
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Andrea Zini
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Loris Poli
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Filomena Caria
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Valeria De Giuli
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Anna Maria Simone
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Rosario Pascarella
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Alessandro Padovani
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Marina Padroni
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Roberto Gasparotti
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Stefano Colagrande
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
| | - Enrico Fainardi
- From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A.P., L.P., F.C., V.D.G., A.P.) and Sezione di Neuroradiologia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica (R.G.), Università degli Studi di Brescia, Italia; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Radiodiagnostica 2 (G.B., S.C.) and Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Struttura Operativa Dipartimentale di Neuroradiologia (E.F.), Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Italia; Unità di Neurologia, Stroke Unit (M.Z.) and Unità di Neuroradiologia (R.P.), Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italia; Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia (M.G.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile S. Agostino Estense, AUSL Modena, Italia (A.Z., A.M.S.); and Unità di Neurologia, Dipartimento di Scienze Biologiche, Psichiatriche e Psicologiche, Università di Ferrara, Italia (M.P.)
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9
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Salottolo K, Wagner J, Frei DF, Loy D, Bellon RJ, McCarthy K, Jensen J, Fanale C, Bar-Or D. Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients. J Am Heart Assoc 2017; 6:JAHA.117.005480. [PMID: 28611097 PMCID: PMC5669171 DOI: 10.1161/jaha.117.005480] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Cerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to describe the epidemiology, treatment, and prognosis of 152 patients with cerebral venous thrombosis. Methods and Results This was a retrospective study of consecutive cerebral venous thrombosis cases from 2006 to 2013 at a comprehensive stroke center through hospital discharge. Predictors of full recovery (modified Rankin Scale scores 0–1) were analyzed with multiple logistic regression and presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The population was young (average age: 42 years), majority female (69%), and commonly presenting with cerebral edema (63%), and 72% were transferred in. All patients received systemic anticoagulation; 49% (n=73) required endovascular treatment. Reasons for requiring endovascular treatment included cerebral edema, herniation, or hemorrhagic infarct (n=38); neurologic decline (n=17); rethrombosis, persistent occlusion, or clot propagation (n=10); extensive clot burden (n=7); and persistent headache despite anticoagulation (n=1). There were 7 (10%) procedural complications. Recanalization was successful (61%), partial (30%), and unsuccessful (9%). Overall, 60% fully recovered. Positive predictors of full recovery included hormonal etiology, particularly for patients who were transferred in (AOR: 7.06 [95% CI, 2.27–21.96], interaction P=0.03) and who had migraine history (AOR: 4.87 [95% CI, 1.01–23.50], P=0.05), whereas negative predictors of full recovery were cerebral edema (AOR: 0.11 [95% CI, 0.04–0.34], P<0.001) and motor weakness (AOR: 0.28 [95% CI, 0.09–0.96], P=0.04). Conclusions As one of the largest cohort studies, our findings suggest that cerebral edema, history of migraine, and hormonal etiology were prognostic and that endovascular treatment might be a safe and effective treatment for cerebral venous thrombosis when conventional management is inadequate.
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Affiliation(s)
| | - Jeffrey Wagner
- Neurology Department, Swedish Medical Center, Englewood, CO
| | - Donald F Frei
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | - David Loy
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | - Richard J Bellon
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | | | - Judd Jensen
- Neurology Department, Swedish Medical Center, Englewood, CO.,Blue Sky Neurology, Englewood, CO
| | - Christopher Fanale
- Neurology Department, Swedish Medical Center, Englewood, CO.,Blue Sky Neurology, Englewood, CO
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Center, Englewood, CO
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10
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Androulakis XM, Kodumuri N, Giamberardino LD, Rosamond WD, Gottesman RF, Yim E, Sen S. Ischemic stroke subtypes and migraine with visual aura in the ARIC study. Neurology 2016; 87:2527-2532. [PMID: 27956563 DOI: 10.1212/wnl.0000000000003428] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/19/2016] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the association among migraine, ischemic stroke, and stroke subtypes in the Atherosclerosis Risk in Communities (ARIC) study. METHODS In this ongoing, prospective, longitudinal community-based cohort study, participants were given an interview ascertaining migraine history in 1993-1995, and were followed for all vascular events, including stroke. All stroke events over the subsequent 20 years were adjudicated and classified into stroke subtypes by standard definitions. Cox proportional hazards models adjusted for stroke risk factors were used to study the relationship between migraine and ischemic stroke, overall, as well as stroke subtypes (cardioembolic, lacunar, or thrombotic). RESULTS We identified 1,622 migraineurs among 12,758 participants. Mean age of the study population at the 3rd clinical visit was 59 years. When compared to nonheadache participants, there was a significant association between migraine with visual aura and ischemic stroke (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.2-2.6, p = 0.008). Migraine without visual aura was not significantly associated with ischemic stroke (HR 1.2, CI 1.0-1.8, p = 0.28) when compared to nonheadache participants. Among the 3 subtypes of ischemic stroke evaluated, migraine with visual aura was significantly associated only with cardioembolic stroke (HR 3.7, 95% CI 1.6-8.7, p = 0.003). CONCLUSION In participants with migraine with visual aura in late middle age, increased risk of cardioembolic stroke was observed. Migraine with visual aura was linked to increased stroke risk, while migraine without visual aura was not, over the period of 20 years. These results are specific to older migraineurs.
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Affiliation(s)
- X Michelle Androulakis
- From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nishanth Kodumuri
- From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lauren D Giamberardino
- From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wayne D Rosamond
- From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eunsil Yim
- From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Souvik Sen
- From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
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11
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Rist PM, Buring JE, Kase CS, Kurth T. Healthy Lifestyle and Functional Outcomes from Stroke in Women. Am J Med 2016; 129:715-724.e2. [PMID: 26899753 PMCID: PMC4914459 DOI: 10.1016/j.amjmed.2016.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE While a healthy lifestyle has been associated with reduced risk of developing ischemic stroke, less is known about its effect on stroke severity. METHODS We performed a prospective cohort study among 37,634 women without stroke or missing risk factor data at baseline. The healthy lifestyle index was composed of smoking, physical activity, body mass index, alcohol consumption, and diet (range 0-20, with 20 representing healthiest lifestyle). Possible functional outcomes were no stroke or stroke with modified Rankin Scale score of 0-1 (mild), 2-3 (moderate), or 4-6 (severe). Multinomial logistic regression was used to analyze the association between healthy lifestyle and functional outcomes from stroke. RESULTS Over 17.2 years of follow-up, 867 total strokes were confirmed. Compared with the lowest category (0-4), the highest category (17-20) was associated with reductions in risk of total stroke with mild (odds ratio [OR] 0.43; 95% confidence interval [CI], 0.20-0.90), moderate (OR 0.53; 95% CI, 0.27-1.06), and severe (OR 0.48; 95% CI, 0.20-1.18) functional outcomes. Even a modest healthy lifestyle index (5-8 points) was associated with significant decreases in total stroke with severe and moderate functional outcomes. Similar results were seen for ischemic but not hemorrhagic strokes. CONCLUSIONS Highest vs lowest scores on the healthy lifestyle index were associated with reductions in risk of total and ischemic strokes with mild, moderate, and severe functional outcomes among women. The evidence that even modest healthy lifestyle index scores reduced risks of total and ischemic stroke with moderate and severe functional outcomes suggests modest lifestyle changes may reduce risk of disabling stroke events.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass.
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Carlos S Kase
- Department of Neurology, Boston University School of Medicine, Mass
| | - Tobias Kurth
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass; Institute of Public Health, Charité Universitätzmedizin, Berlin, Germany
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12
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Gan’shina TS, Gorbunov AA, Gnezdilova AV, Turilova AI, Kostochka LM, Pyatin BM, Avdyunina NI, Grushevskaya LN, Mirzoyan RS. Tropoxin – Drug for the Treatment of Migraine. Pharm Chem J 2016. [DOI: 10.1007/s11094-016-1391-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Peng KP, Chen YT, Fuh JL, Tang CH, Wang SJ. Migraine and incidence of ischemic stroke: A nationwide population-based study. Cephalalgia 2016; 37:327-335. [DOI: 10.1177/0333102416642602] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The association between migraine and the incidence of ischemic stroke varies in different subgroups of patients. We aimed to clarify this association using a population-based database. Method A nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Two cohorts were extracted: a neurologist-diagnosed migraine cohort, and a non-headache, propensity score-matched comparison cohort. All participants were enrolled in this study between 2005 and 2009, and were followed through the end of 2010, death, or the occurrence of ischemic stroke. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated with a Cox proportional hazards model to compare the between-group risks. Results Both cohorts ( n = 119,017 each) were followed for a mean period of 3.6 ± 1.3 years. A total of 744 migraine patients (429,741 person-years) and 617 matched comparison individuals (436,141 person-years) developed ischemic stroke during the research period. Compared to the comparison cohort, patients with migraine were at an increased risk of ischemic stroke (aHR: 1.24, 95% CI: 1.12–1.38, p < 0.001). Subgroup analysis by age and sex revealed the highest risk in women aged ≤ 45 years (aHR: 3.44, 95% CI: 2.20–5.39, p < 0.001), especially among those with migraine with aura (aHR: 4.58, 95% CI: 2.45 – 8.56, p < 0.001). A trend for increased stroke risk was observed in men aged ≤ 45 years (aHR: 1.54, 95% CI: 0.96–2.48, p = 0.075). Conclusion Migraine is associated with an increased risk of ischemic stroke, especially in younger (age ≤ 45 years) women with migraine with aura. The trend toward ischemic stroke in younger men merits further exploration.
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Affiliation(s)
- Kuan-Po Peng
- Department of Internal Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taiwan
- National Yang-Ming University School of Medicine, Taiwan
| | - Yung-Tai Chen
- National Yang-Ming University School of Medicine, Taiwan
- Department of Nephrology, Institute of Internal Medicine, Taipei City Hospital Heping Fuyou Branch, Taiwan
| | - Jong-Ling Fuh
- National Yang-Ming University School of Medicine, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taiwan
| | - Shuu-Jiun Wang
- Institute of Brain Science, National Yang-Ming University, Taiwan
- National Yang-Ming University School of Medicine, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
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Albieri V, Olsen TS, Andersen KK. Risk of Stroke in Migraineurs Using Triptans. Associations with Age, Sex, Stroke Severity and Subtype. EBioMedicine 2016; 6:199-205. [PMID: 27211561 PMCID: PMC4856739 DOI: 10.1016/j.ebiom.2016.02.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Identifying migraineurs by triptan utilization we studied risk for stroke in migraineurs compared to the general population. METHODS A cohort study including all citizens 25-80years of age in Denmark 2003-2011 was conducted. All persons prescribed triptans, and all those hospitalized for a first stroke were identified in the Danish Registries. Information on stroke severity/subtype and cardiovascular risk factors was available for stroke patients. FINDINGS Of the 49,711 patients hospitalized for a first stroke, 1084 were migraineurs using triptans. Adjusting for age, sex, income, and educational level, risk for stroke was higher among migraineurs in respect to all strokes (RR 1.07; CI 1.01-1.14) and ischemic strokes (RR 1.07; CI 1.00-1.14). Risk for hemorrhagic stroke was increased but only in women (RR 1.41; CI 1.11-1.79). Risk was for mild strokes (RR 1.31; CI 1.16-1.48) while risk for severe strokes was lower among migraineurs (RR 0.77; CI 0.65-0.91). Risk was age-related; highest among women 25-45years (RR≈1.7). Risk was unrelated to numbers of dispensations. INTERPRETATION Migraineurs identified by triptan utilization had higher risk for stroke. Strokes were minor and cardiovascular risk factors were less prevalent pointing to a migraine-specific etiology of stroke different from that of thromboembolism.
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Affiliation(s)
- Vanna Albieri
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
| | - Tom Skyhøj Olsen
- Department of Neurology, Bispebjerg University Hospital, 2400 Copenhagen, Denmark.
| | - Klaus Kaae Andersen
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
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15
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de Falco FA, de Falco A. Migraine with aura: which patients are most at risk of stroke? Neurol Sci 2016; 36 Suppl 1:57-60. [PMID: 26017513 DOI: 10.1007/s10072-015-2132-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The complex association between migraine (M) and ischemic stroke (IS) is discussed. Epidemiological studies and meta-analyses show that M with aura (MA) and not M without aura, doubles the risk of IS. The risk is higher for female gender, young age and higher headache attacks frequency. Smoking habit and oral contraceptives, especially if associated, increase stroke risk. The underlying pathogenetic mechanisms are not completely understood, but it is hypothesized that a particular brain susceptibility to cortical spread depression could explain the association between MA and IS. The absolute risk of IS in migraineurs is relatively low and an antithrombotic primary prevention is not indicated, but it is mandatory to investigate and treat associated risk factors for IS and, in young MA women, consider only progestinic oral contraceptives, if needed, and smoking cessation.
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Affiliation(s)
- F A de Falco
- Neurological Care Unit, Loreto Nuovo Hospital, ASL Napoli 1 Centro, Via Amerigo Vespucci, 80142, Naples, Italy,
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16
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17
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Li L, Schulz UG, Kuker W, Rothwell PM. Age-specific association of migraine with cryptogenic TIA and stroke: Population-based study. Neurology 2015; 85:1444-51. [PMID: 26423431 DOI: 10.1212/wnl.0000000000002059] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/24/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether there is an association between previous migraine and cryptogenic TIA or ischemic stroke at older ages. METHODS We determined the age-specific associations of history of migraine and Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtype of TIA and ischemic stroke in a population-based cohort study (Oxford Vascular Study; 2002-2012). RESULTS Among 1,810 eligible patients with TIA or ischemic stroke, 668 (36.9%) had cryptogenic events, of whom 187 (28.0%) had previous migraine. Migraine was more commonly associated with cryptogenic events than with those of known etiology (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.38-2.16, p < 0.0001; cardioembolic 2.00, 1.50-2.66, p < 0.0001; large artery 1.75, 1.20-2.53, p = 0.003; small vessel 1.32, 0.95-1.83, p = 0.096). The association of migraine with cryptogenic events was independent of age, sex, and all measured vascular risk factors (RFs) (adjusted OR 1.68, 1.33-2.13, p < 0.0001) and was strongest at older ages (<55 years, OR 1.11, 0.55-2.23; 55-64 years, 1.48, 0.83-2.63; ≥65 years, 1.81, 1.39-2.36) and in patients without vascular RFs (0 RFs OR 2.62, 1.33-5.15; 1 RF 2.01, 1.35-3.01; 2 RFs 1.80, 1.21-2.68; 3 RFs 1.21, 0.71-2.07; 4 RFs 0.92, 0.28-2.99). Results were consistent for migraine with or without aura and for analyses excluding TIA or stratified by sex or vascular territory of event. CONCLUSIONS In this population-based study of stroke etiology stratified by age, migraine was most strongly associated with cryptogenic TIA and ischemic stroke, particularly at older ages, suggesting a causal role or a shared etiology.
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Affiliation(s)
- Linxin Li
- From the Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - Ursula G Schulz
- From the Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - Wilhelm Kuker
- From the Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - Peter M Rothwell
- From the Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK.
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18
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Abstract
Migraine is a common disabling neurological disorder resulting from excessive cortical excitation and trigeminovascular afferent sensitization. In addition to aberrant neuronal processing, migraineurs are also at significant risk of vascular disease. Consequently, the impact of migraine extends well beyond the ictal headache and includes a well-documented association with acute ischemic stroke, particularly in young women with a history of migraine with aura. The association between migraine and stroke has been acknowledged for 40 years or more. However, examining the pathobiology of this association has become a more recent and critically important undertaking. The diversity of mechanisms underlying the association between migraine and stroke likely reflects the heterogenous nature of this disorder. Vasospasm, endothelial injury, platelet aggregation and prothrombotic states, cortical spreading depression, carotid dissection, genetic variants, and traditional vascular risk factors have been offered as putative mechanisms involved in migraine-related stroke risk. Assimilating these seemingly divergent pathomechanisms into a cogent understanding of migraine-related stroke will inform future studies and the development of new strategies for the prevention and treatment of migraine and stroke.
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Affiliation(s)
- Andrea M Harriott
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA,
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19
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Lantz M, Kostulas K, Waldenlind E, Sjöstrand C. Prevalence of migraine headache in an in-patient stroke population. Acta Neurol Scand 2015; 131:290-7. [PMID: 25346043 DOI: 10.1111/ane.12341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Migraine, especially with aura, is a risk factor for ischemic stroke. In this study, we investigated descriptive data and prevalence of migraine in an in-patient stroke population. MATERIALS AND METHODS Patients with acute cerebrovascular disease (CVD) admitted to the stroke unit during a 6-month period were recruited. Prevalence of migraine was assessed using a structured questionnaire. Additional clinical data regarding risk factors for CVD were evaluated for all responding patients. RESULTS A total of 229 patients received a questionnaire and 175 answers were collected (response frequency of 76.4%). Responders matched the initial cohort regarding distribution of age, sex, and type of stroke. Thirty-six cases (20.6%) fulfilled the criteria for migraine or probable migraine according to the 2nd edition of the International Headache Classification (ICHD-2). Sixty percent of migraine patients had migraine with aura. Stroke patients with migraine were younger (P = 0.007), the presence of patent foramen ovale (PFO) was significantly increased (P = 0.008), and atrial fibrillation was less common (P = 0.048). There were no other differences between patients with and without migraine headache regarding conventional risk factors. CONCLUSIONS The prevalence of migraine in this hospital-based stroke cohort was comparable to the estimated prevalence of migraine usually described in population studies. In our study population, the prevalence of migraine with aura was higher than expected. The increased prevalence of PFO in patients with migraine headache corresponds well to previous population studies.
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Affiliation(s)
- M. Lantz
- Karolinska Institute; Department of Neurology; Karolinska University Hospital; Stockholm Sweden
| | - K. Kostulas
- Karolinska Institute; Department of Neurology; Karolinska University Hospital; Stockholm Sweden
| | - E. Waldenlind
- Karolinska Institute; Department of Neurology; Karolinska University Hospital; Stockholm Sweden
| | - C. Sjöstrand
- Karolinska Institute; Department of Neurology; Karolinska University Hospital; Stockholm Sweden
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20
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Abstract
Numerous data have pointed to an association between migraine and cardiovascular diseases. The majority of the available data have indicated that migraine with aura can be considered a risk factor for ischemic stroke, whereas migraine without aura cannot be reliably considered as such. High frequency of attacks and a recent onset of migraine have been related to an increased ischemic stroke risk. In addition, in young subjects with ischemic stroke migraine with aura represents an independent risk factor of overall recurrent vascular events and of recurrent ischemic stroke. Also the risk of transient ischemic attack seems to be increased in migraineurs, although this issue has not been extensively investigated. Several studies have also addressed the possible association between migraine and hemorrhagic stroke. Although the results of these individual studies were conflicting, their meta-analysis showed that migraine is associated with a 1.5-fold increase in the risk of hemorrhagic stroke (including intracerebral and subarachnoid hemorrhage). Some studies have identified migraine also as a possible risk factor for cardiac vascular events while others have yielded negative results. A meta-analysis did not show an increased risk of myocardial infarction in subjects with any migraine vs no migraine but subsequently, data has pointed to an association between any migraine with cardiac ischemic disease. Migraine has also been associated by some studies with vascular mortality and with vascular diseases in regions other than the brain and the heart. Several studies have also indicated that compared with nonmigraineurs, migraineurs have a higher burden of asymptomatic white matter brain lesions and, according to some studies, also infarct-like lesions at brain magnetic resonance. The mechanisms underlying the relationship between migraine and cardiovascular disease are still unclear. The possible explanation may rely on a peculiar vascular vulnerability of migraineurs that may contribute to the pathogenesis of migraine and, in the presence of some other unknown factors may also contribute, over time, to the development of cardiovascular disease. At the moment, there are no reliable features that may indicate which subjects, across the overall migraine population, will develop vascular events and so far, no drugs are recommended for the vascular prevention in migraineurs unless other clear indications are present. In general, the acute treatment and the secondary prevention measures of a patient with stroke who has a history of migraine do not differ from that of other stroke patients. There is currently no direct evidence to support that a migraine prophylactic treatment will reduce future stroke risk in secondary prevention.
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Affiliation(s)
- Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Division of Clinical Neurology, University of L'Aquila, 67100, L'Aquila, Italy,
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21
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Gelfand AA, Fullerton HJ, Jacobson A, Sidney S, Goadsby PJ, Kurth T, Pressman A. Is migraine a risk factor for pediatric stroke? Cephalalgia 2015; 35:1252-60. [PMID: 25754176 DOI: 10.1177/0333102415576222] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
Abstract
IMPORTANCE Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in ischemic stroke risk. OBJECTIVE In this cohort study we examine the association between migraine and stroke among children in Kaiser Permanente Northern California (KPNC). DESIGN, SETTING, AND PARTICIPANTS Children ages 2-17 years who were members of KPNC for ≥6 months between 1997 and 2007 were included. Migraine cohort members had one or more of: an ICD-9 code for migraine, migraine listed as a significant health problem, or a prescription for a migraine-specific medication. The comparison group was children with no evidence of headache. MAIN OUTCOME MEASURES Main outcome measures included stroke incidence rates and incidence rate ratios (IR). RESULTS Among the 1,566,952 children within KPNC during the study period, 88,164 had migraine, and 1,323,142 had no evidence of headache. Eight migraineurs had a stroke (three (38%) hemorrhagic; five (63%) ischemic). Eighty strokes occurred in children without headache (53 (66%) hemorrhagic; 27 (34%) ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8-5.2). A post-hoc analysis of adolescents (12-17 years) showed an increased risk of ischemic stroke among those with migraine; IR 3.4 (95% CI 1.2-9.5). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person-years in those without headache; IR 0.6 (95% CI 0.2-2.0). CONCLUSIONS There was no statistically significant increase in hemorrhagic or ischemic stroke risk in pediatric migraineurs in this cohort study. A post-hoc analysis found that ischemic stroke risk was significantly elevated in adolescents with migraine. Future studies should focus on identifying risk factors for ischemic stroke among adolescent migraineurs. Based on adult data, we recommend that migraine aura status should be studied as a possible risk factor for ischemic stroke among adolescent migraineurs.
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Affiliation(s)
- Amy A Gelfand
- UCSF Headache Center, Department of Neurology, University of California San Francisco, USA Division of Child Neurology, UCSF, USA
| | | | - Alice Jacobson
- Sutter Health Research Development and Dissemination, USA Kaiser Permanente Northern California, Division of Research Oakland, USA
| | - Stephen Sidney
- Kaiser Permanente Northern California, Division of Research Oakland, USA
| | - Peter J Goadsby
- UCSF Headache Center, Department of Neurology, University of California San Francisco, USA NIHR-Wellcome Trust Clinical Research Facility, King's College London, UK
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897) - Team Neuroepidemiology, France University of Bordeaux, College of Health Sciences, France
| | - Alice Pressman
- Sutter Health Research Development and Dissemination, USA Kaiser Permanente Northern California, Division of Research Oakland, USA
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Butt JH, Franzmann U, Kruuse C. Endothelial function in migraine with aura - a systematic review. Headache 2014; 55:35-54. [PMID: 25546573 DOI: 10.1111/head.12494] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increased risk of ischemic stroke is repeatedly reported in young subjects with migraine with aura (MA). Such may be caused by changes in endothelial function. The present review evaluates current evidence on endothelial function in MA patients. METHODS A systematic search of electronic databases (Medline, Embase, Cochrane library) was performed, and a search in associated reference lists of identified studies was done. RESULTS In total, 27 studies met inclusion criteria for this review. Six studies assessed endothelial function by flow-mediated dilation; four reported no differences compared with healthy subjects, one study reported an increase and one study a decrease in migraineurs. Peripheral arterial tonometry was applied in one study where no changes were detected between groups. Likewise, applying venous occlusion plethysmography elicited comparable responses. Arterial function was investigated in six studies; increased augmentation index and decreased arterial distensibility were reported in migraineurs, whereas findings regarding pulse wave velocity were dissimilar. However, when investigating levels of endothelial progenitor cells, two studies reported reduced levels in migraineurs, and several studies on endothelial markers in the areas of inflammation, oxidative stress, and coagulation found increased endothelial activation in migraineurs, particularly in MA. One study, assessing cerebral endothelial function using transcranial Doppler sonography, reported lower cerebrovascular reactivity to L-arginine in the posterior cerebral arteries in migraineurs. CONCLUSION Endothelial dysfunction appears not to be of importance in MA patients. However, the studies were few with a wide variety of techniques applied in small groups of patients. Endothelial biomarkers were increased in patients indicating a possible subtle change in the endothelium. Further investigations on larger groups of patients combining testing of endothelial dysfunction as well as biomarkers are warranted to identify whether or not endothelial changes may play a role in the increased risk of stroke in young MA patients.
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Affiliation(s)
- Jawad H Butt
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital Herlev, Herlev, Denmark
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Sacco S, Pistoia F, Degan D, Carolei A. Conventional vascular risk factors: their role in the association between migraine and cardiovascular diseases. Cephalalgia 2014; 35:146-64. [PMID: 25505017 DOI: 10.1177/0333102414559551] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Migraine, in particular migraine with aura, has been found to be associated with cardiovascular disease. However, the role of conventional vascular risk factors in the association is still debated. The aim of the present review is to address the association between migraine and conventional cardiovascular risk factors as well as to address their possible role in the association between migraine and cardiovascular disease. METHODS Data for this review were obtained through searches in multiple sources up to May 2014 using the terms "migraine" OR "headache" in combination with all the vascular risk factors of interest. RESULTS Data about the possible association between migraine and high blood pressure values are heterogeneous, hindering any final conclusion. Data addressing the possible association between migraine and diabetes mellitus indicate the lack of any association or in some cases a negative association between the two conditions. The body of evidence on the role of dyslipidemia in migraineurs is relatively homogeneous and, with few exceptions, reports an association between migraine and an unfavorable lipid profile; however, the difference in lipid levels between migraineurs and non-migraineurs is small and its clinical implication unclear. Regarding obesity, a trend has been observed of increased risk of migraine with increasing obesity, especially in young patients, albeit in the midst of conflicting data. Evidence about the association between cigarette smoking and migraine mostly indicates that migraineurs are more commonly smokers than non-migraineurs. On the other hand, the majority of the available studies report less alcohol use in migraineurs than in non-migraineurs. Finally, many of the available studies suggest a more frequent family history of cardiovascular disease in migraineurs as compared to non-migraineurs. Since most of the studies that supported the association between migraine and cardiovascular disease adjusted the analyses for the presence of several vascular risk factors, they cannot entirely explain this association. CONCLUSIONS Based on the available reported data, it seems unlikely that the higher risk of cardiovascular disease in migraineurs is mediated by any single vascular risk factor. For this reason the role of specific interactions among risk factors with the contribution of genetic, environmental, personality and psychological factors should be appropriately investigated.
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Affiliation(s)
- Simona Sacco
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Francesca Pistoia
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Diana Degan
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Antonio Carolei
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
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Abstract
BACKGROUND Migraine, particularly with aura, increases the risk for ischemic stroke, at least in a subset of patients. The underlying mechanisms are poorly understood and probably multifactorial. METHODS We carried out an extended literature review of experimental and clinical evidence supporting the association between migraine and ischemic stroke to identify potential mechanisms that can explain the association. RESULTS Observational, imaging and genetic evidence support a link between migraine and ischemic stroke. Based on clinical and experimental data, we propose mechanistic hypotheses to explain the link, such as microembolic triggers of migraine and enhanced sensitivity to ischemic injury in migraineurs. DISCUSSION We discuss the possible practical implications of clinical and experimental data, such as aggressive risk factor screening and management, stroke prophylaxis and specific acute stroke management in migraineurs. However, evidence from prospective clinical trials is required before modifying the practice in this patient population.
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Affiliation(s)
- Jerome Mawet
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Emergency Headache Center, Lariboisiere Hospital, Assistance Publique-Hopitaux de Paris, France DHU NeuroVasc, France
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, France University of Bordeaux, College of Health Sciences, France Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA
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Rist PM, Glymour MM, Orav EJ, Kim E, Kase CS, Buring JE, Kurth T. Non-steroidal anti-inflammatory drug use and functional outcome from ischemic cerebral events among women. Eur J Intern Med 2014; 25:255-8. [PMID: 24525385 PMCID: PMC3970177 DOI: 10.1016/j.ejim.2014.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/13/2014] [Accepted: 01/20/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Use of some non-steroidal anti-inflammatory drugs (NSAIDs) has been linked to an increased risk of stroke. However, information on the impact of NSAID use on functional outcomes from stroke is limited. METHODS Using women enrolled in the Women's Healthy Study who were free of a history of stroke or TIA at baseline, a prospective cohort study was performed to examine the impact of NSAID use on functional outcomes from stroke. Women were classified as NSAID non-user (<11 days of use in the past month), user (≥ 11 days of use in the past month), and missing (did not answer the question about NSAID use) during each year of the study. Possible functional outcomes were TIA or ischemic stroke with modified Rankin scale (mRS) score of 0 to 1, 2 to 3, or 4 to 6. RESULTS After 15.7 mean years of follow-up, 702 TIAs, 292 ischemic strokes with mRS 0-1, 233 ischemic strokes with mRS 2-3 and 98 ischemic strokes with mRS 4-6 occurred. Compared to women who were NSAID non-users, women who were NSAID users had multivariable-adjusted (95% CI) of 1.00 (0.77, 1.29) for TIA, 1.48 (1.04, 2.10) for mRS 0-1, 0.83 (0.52, 1.33) for mRS 2-3, and 1.33 (0.68, 2.59) for mRS 4-6. CONCLUSION Results from this large cohort study suggest than NSAID use may be associated with an increased risk of ischemic stroke with mild functional outcome.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States.
| | - M Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, United States
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
| | - Eunjung Kim
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Carlos S Kase
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States
| | - Tobias Kurth
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; Inserm Research Center for Epidemiology and Biostatistics (U897), Bordeaux, France, Bordeaux, France; College of Health Sciences, University of Bordeaux, Bordeaux, France
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Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:1545-88. [PMID: 24503673 PMCID: PMC10152977 DOI: 10.1161/01.str.0000442009.06663.48] [Citation(s) in RCA: 617] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. CONCLUSIONS To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.
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Sacco S, Altobelli E, Ornello R, Ripa P, Pistoia F, Carolei A. Insulin resistance in migraineurs: results from a case-control study. Cephalalgia 2013; 34:349-56. [PMID: 24243987 DOI: 10.1177/0333102413511155] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Several studies have suggested an association between migraine and insulin resistance (IR) without adequately addressing the issue according to migraine type. We assessed IR in subjects with migraine with aura (MwA) and migraine without aura (MwoA) to estimate the consistency of the possible association. METHODS In a case-control study we included case subjects with MwA and MwoA, who were consecutively selected from those referred to our Regional Headache Center from September 2011 to February 2013, and age-matched control subjects selected using general practitioners' databases. IR was calculated by means of the homeostatic model assessment of IR (HOMA-IR), β-cell function (HOMA-B), and the quantitative insulin sensitivity check index (QUICKI) measuring glucose and insulin values in a blood sample collected in the morning after overnight fasting. Data regarding anthropometric measures, comorbidity risk factors, and migraine characteristics were also recorded. RESULTS We recruited 50 case subjects with MwA (38 women) and 50 with MwoA (40 women) and 50 control subjects (40 women). Proportions of arterial hypertension, cigarette smoking, hypercholesterolemia, use of oral contraceptives, and mean values of the body mass index (BMI) were similar in the three groups. We found significantly different glucose values among and within groups considering case subjects with MwA and MwoA and control subjects (4.9 ± 0.6 vs 4.7 ± 0.5 vs 4.6 ± 0.5 mmol/l; P = 0.018) in the absence of any difference in insulin (53.1 ± 24.0 vs 56.7 ± 34.4 vs 53.8 ± 24.4 pmol/l; P = 0.811), HOMA-IR (1.6 ± 0.8 vs 1.7 ± 1.0 vs 1.6 ± 0.7; P = 0.765), HOMA-B (121.4 ± 71.1 vs 149.2 ± 93.8 vs 162.8 ± 109.7; P = 0.107), and QUICKI (0.36 ± 0.03 vs 0.37 ± 0.03 vs 0.37 ± 0.03; P = 0.877) values. The logistic regression model showed increased odds of MwA in subjects exposed to the highest tertile of glucose values. This association was confirmed in the adjusted model, in which case subjects with MwA were compared with those with MwoA but not with control subjects. CONCLUSIONS In contrast to what has been shown by the majority of the available studies, the results of our study do not support the association of migraine with IR. As our study was not population-based and several patients had low disease activity, these findings need further confirmation.
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Affiliation(s)
- S Sacco
- Department of Neurology and Regional Headache Center, University of L'Aquila, Italy
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Sacco S, Ripa P, Grassi D, Pistoia F, Ornello R, Carolei A, Kurth T. Peripheral vascular dysfunction in migraine: a review. J Headache Pain 2013; 14:80. [PMID: 24083826 PMCID: PMC3849862 DOI: 10.1186/1129-2377-14-80] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022] Open
Abstract
Numerous studies have indicated an increased risk of vascular disease among migraineurs. Alterations in endothelial and arterial function, which predispose to atherosclerosis and cardiovascular diseases, have been suggested as an important link between migraine and vascular disease. However, the available evidence is inconsistent. We aimed to review and summarize the published evidence about the peripheral vascular dysfunction of migraineurs.We systematically searched in BIOSIS, the Cochrane database, Embase, Google scholar, ISI Web of Science, and Medline to identify articles, published up to April 2013, evaluating the endothelial and arterial function of migraineurs.Several lines of evidence for vascular dysfunction were reported in migraineurs. Findings regarding endothelial function are particularly controversial since studies variously indicated the presence of endothelial dysfunction in migraineurs, the absence of any difference in endothelial function between migraineurs and non-migraineurs, and even an enhanced endothelial function in migraineurs. Reports on arterial function are more consistent and suggest that functional properties of large arteries are altered in migraineurs.Peripheral vascular function, particularly arterial function, is a promising non-invasive indicator of the vascular health of subjects with migraine. However, further targeted research is needed to understand whether altered arterial function explains the increased risk of vascular disease among patients with migraine.
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Affiliation(s)
- Simona Sacco
- Department of Neurology and Regional Headache Center, University of L'Aquila, Piazzale Salvatore Tommasi 1, L'Aquila, 67100, Italy.
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Rist PM, Buring JE, Kase CS, Kurth T. Effect of low-dose aspirin on functional outcome from cerebral vascular events in women. Stroke 2013; 44:432-6. [PMID: 23306328 DOI: 10.1161/strokeaha.112.672451] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Although aspirin is effective in prevention of stroke, fewer studies have examined the impact of aspirin on stroke morbidity. METHODS The Women's Health Study is a completed randomized, placebo-controlled trial designed to test the effect of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer, which enrolled 39 876 women. We used multinomial logistic regression to evaluate the relationship between randomized aspirin assignment and functional outcomes from stroke. Possible functional outcomes were neither stroke nor transient ischemic attack (TIA), modified Rankin scale (mRS) score 0 to 1, 2 to 3, and 4 to 6. RESULTS After a mean of 9.9 years of follow-up, 460 confirmed strokes (366 ischemic, 90 hemorrhagic, and 4 unknown type) and 405 confirmed TIAs occurred. With regard to total and ischemic stroke, women who were randomized to aspirin had a nonsignificant decrease in risk of any outcome compared to women not randomized to aspirin. This decrease in risk only reached statistical significance for those experiencing TIA compared to participants without stroke or TIA (odds ratio=0.77; 95% confidence interval, 0.63-0.94). For hemorrhagic stroke, a nonsignificant increase in the risk of achieving an mRS score 2 to 3 or 4 to 6 compared with no stroke or TIA was observed for the women randomized to aspirin compared to those randomized to placebo. CONCLUSIONS Results from this large randomized clinical trial provide evidence that 100 mg of aspirin every other day may reduce the risk of ischemic cerebral vascular events but does not have differential effects on functional outcomes from stroke.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA.
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Gonçalves FM, Martins-Oliveira A, Lacchini R, Belo VA, Speciali JG, Dach F, Tanus-Santos JE. Matrix metalloproteinase (MMP)-2 gene polymorphisms affect circulating MMP-2 levels in patients with migraine with aura. Gene 2013; 512:35-40. [DOI: 10.1016/j.gene.2012.09.109] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/23/2012] [Accepted: 09/29/2012] [Indexed: 11/24/2022]
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Stam AH, Weller CM, Janssens ACJ, Aulchenko YS, Oostra BA, Frants RR, van den Maagdenberg AM, Ferrari MD, van Duijn CM, Terwindt GM. Migraine is not associated with enhanced atherosclerosis. Cephalalgia 2012; 33:228-35. [PMID: 23147163 DOI: 10.1177/0333102412466966] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Migraine, in particular with aura, has been associated with an increased risk for ischemic stroke and coronary heart disease. The underlying mechanism is unknown. In a cross-sectional case control study we investigated whether an enhanced risk of atherosclerosis in migraineurs explains this increased cardiovascular risk. METHODS Subjects were participants from the population-based Erasmus Rucphen Family study. Atherosclerosis was assessed in 360 migraineurs (209 without aura and 151 with aura) and 617 subjects without migraine or severe headache. Atherosclerosis was quantified by intima media thickness, pulse wave velocity and ankle-brachial index. RESULTS Migraineurs, especially with aura, were found more likely to smoke, have diabetes or a modestly decreased HDL-cholesterol. No differences were found for the atherosclerosis parameters. CONCLUSION In this large population-based study, migraineurs have no increased risk of atherosclerosis. Therefore, enhanced atherosclerosis is an unlikely explanation for the increased cardiovascular risk seen in migraineurs.
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Affiliation(s)
- Anine H Stam
- Department of Neurology, Leiden University Medical Centre, The Netherlands
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Migraine and subsequent risk of breast cancer: a prospective cohort study. Cancer Causes Control 2012; 24:81-9. [PMID: 23143336 DOI: 10.1007/s10552-012-0092-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/26/2012] [Indexed: 01/04/2023]
Abstract
PURPOSE Previous studies have suggested that migraineurs are at decreased risk for developing breast cancer. Further prospective studies are warranted to confirm these results. In addition, studies evaluating migraine characteristics (e.g., migraine subtypes and frequency) are lacking. METHODS We conducted a prospective cohort study among 39,696 participants in the Women's Health Study who were 45 years and older at study entry. Information on migraine was self-reported with good validation rates. Incident breast cancer cases were confirmed by medical record review. We distinguished the following major endpoints: any breast cancer, a combined endpoint of invasive and in situ cases, in situ breast cancer only, and invasive breast cancer only. Cox proportional hazards models were used to calculate age- and multivariable-adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CI). RESULTS A total of 7,318 (18.4 %) women reported any migraine. During a mean follow-up time of 13.6 years, 432 in situ and 1,846 invasive breast cancer cases occurred. Migraine was not associated with breast cancer risk. The multivariable-adjusted HRs (95 % CI) were 1.10 (0.99-1.22) for any breast cancer, 1.06 (0.83-1.35) for in situ breast cancer, and 1.11 (0.99-1.25) for invasive breast cancer. The risk for developing breast cancer differed according to hormone receptor status with a suggestion of increased risks for hormone receptor negative tumors (HR ER-/PR- : 1.28, 95 % CI: 0.96-1.71). We did not observe meaningful differences with regard to histologic subtype or according to migraine aura status or migraine attack frequency. CONCLUSIONS Results of our study do not support the hypothesis that migraineurs have a decreased risk for breast cancer.
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Rist PM, Buring JE, Kase CS, Ridker PM, Kurth T. Biomarkers and functional outcomes from ischaemic cerebral events in women: a prospective cohort study. Eur J Neurol 2012; 20:375-81. [PMID: 23034002 DOI: 10.1111/j.1468-1331.2012.03874.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 08/17/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Several biomarkers have been associated with an increased risk of ischaemic stroke. However, the association between these biomarkers and functional outcome from cerebral ischaemic events is unclear. We aimed to assess the patterns of association between cardiovascular disease biomarkers and functional outcomes after incident ischaemic cerebral events in women. METHODS Prospective cohort study of 27,728 women enrolled in the Women's Health Study who provided information on blood samples and were free of stroke or transient ischaemic attack (TIA) at baseline. Multinomial logistic regression was used to determine the association between elevated biomarker levels and functional outcomes from ischaemic cerebral events. Possible functional outcomes included TIA and ischaemic stroke with modified Rankin Scale (mRS) score of 0-1, 2-3, or 4-6. RESULTS After a mean follow-up of 15.1 years, 461 TIAs and 380 ischaemic strokes occurred. Elevated levels of total cholesterol were associated with the highest risk of poor functional outcome (mRS 4-6) after incident cerebral ischaemic events (relative risk = 2.02, 95% CI = 1.18-3.46). We observed significant associations between elevated levels of total cholesterol, Lp(a), C-reactive protein, and triglycerides, and mild or moderate functional outcomes after ischaemic cerebral events. Elevations in all other biomarkers were not significantly associated with functional outcomes. CONCLUSIONS Whilst total cholesterol level was associated with highest risks of poor functional outcome after stroke, we overall observed an inconsistent pattern of association between biomarkers linked with an increased risk of vascular events and more impaired functional outcomes from stroke.
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Affiliation(s)
- P M Rist
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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Affiliation(s)
- Tobias Kurth
- Inserm Unit 708-Neuroepidemiology, Université Bordeaux Segalen, 146 rue Léo Saignat, case 11, 33076 Bordeaux, France.
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Winter AC, Wang L, Buring JE, Sesso HD, Kurth T. Migraine, weight gain and the risk of becoming overweight and obese: a prospective cohort study. Cephalalgia 2012; 32:963-71. [PMID: 22875879 DOI: 10.1177/0333102412455708] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Some cross-sectional studies have suggested an association between migraine and increased body weight. However, prospective data on the association are lacking. METHODS We conducted a prospective cohort study among 19,162 participants in the Women's Health Study who had a body mass index (BMI) of 18.5- <25 kg/m(2) at baseline. Migraine was self-reported by standardized questionnaires. Main outcome measures were incident overweight (BMI ≥ 25 kg/m(2)), incident obesity (BMI ≥ 30 kg/m(2)) and mean weight change. Age- and multivariable-adjusted hazard ratios (HRs) were calculated for the association between migraine and incident overweight and obesity. Differences in weight change were evaluated by analysis of covariance (ANCOVA). RESULTS A total of 3,483 (18.2%) women reported any migraine history. After 12.9 years of follow-up, 7916 incident overweight and 730 incident obesity cases occurred. Migraineurs had multivariable-adjusted HRs (95% confidence interval) of 1.11 (1.05-1.17) for becoming overweight and 1.00 (0.83-1.19) for becoming obese. These associations remained stable after censoring for chronic diseases and were similar according to migraine aura status. Multivariable-adjusted mean weight change from baseline to the end of study was +4.7 kg for migraineurs and +4.4 kg for women without migraine (p = 0.02). CONCLUSION Results of this large prospective study of middle-aged women do not indicate a consistent association between migraine and incident overweight, obesity or relevant weight gain.
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Affiliation(s)
- Anke C Winter
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
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Sacco S, Ricci S, Carolei A. Migraine and vascular diseases: a review of the evidence and potential implications for management. Cephalalgia 2012; 32:785-95. [PMID: 22711902 DOI: 10.1177/0333102412451361] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The higher-than-expected incidence of vascular diseases reported in migraineurs suggests that migraine may, in some cases, be a dangerous condition rather than just a distressing but harmless disorder. We provide a systematic review of data linking migraine to vascular diseases. MIGRAINE AND VASCULAR DISEASES Available data indicate an increased risk of ischemic stroke in subjects suffering from migraine with aura. In addition, evidence suggests an association between migraine with aura and cardiac disease, intracerebral hemorrhage, retinal vasculopathy and mortality that needs to be further corroborated; consequently, for those conditions, migraine with aura can be only considered among the less-well-documented risk factors. As the absolute risk of ischemic stroke in the overall migraineur population is low, subjects suffering from migraine with aura should be made aware of the possible link but not unduly alarmed. It is a common notion that the vascular risk of migraineurs may be further increased by the presence of easily treatable vascular risk factors such as arterial hypertension, cigarette smoking and oral contraceptive use. CONCLUSIONS Forthcoming guidelines should appropriately recommend supporting migraineurs not only with measures aimed at decreasing headache frequency, thus improving quality of life, but also with general measures and preventive strategies aimed to reduce the overall vascular risk. In fact, headache specialists should take care not only of relieving pain but also of assessing and treating concurrent vascular risk factors, while gynecologists, in particular, should routinely consider the presence and type of migraine before prescribing oral contraceptives.
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Affiliation(s)
- Simona Sacco
- Department of Neurology, University of L'Aquila, Italy.
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Kurth T, Chabriat H, Bousser MG. Migraine and stroke: a complex association with clinical implications. Lancet Neurol 2012; 11:92-100. [PMID: 22172624 DOI: 10.1016/s1474-4422(11)70266-6] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Migraine and stroke are two common and heterogeneous neurovascular disorders with complex relations. Data show no firm association between stroke and migraine without aura--by far the most common type of migraine--but a doubling of the risk of ischaemic stroke in people who have migraine with aura. Migraine with aura is characterised by a low brain threshold for cortical spreading depression, the biological substrate of the aura, which can be triggered by many factors, including specific diseases that can by themselves increase the risk of ischaemic stroke. Whether the increased risk of ischaemic stroke applies to migraine with aura as a primary headache disorder or is partly due to migraine with aura secondary to other disorders remains to be elucidated.
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Affiliation(s)
- Tobias Kurth
- Inserm Unit 708-Neuroepidemiology, University of Bordeaux, Bordeaux, France
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Kurth T, Diener HC, Buring JE. Migraine and cardiovascular disease in women and the role of aspirin: subgroup analyses in the Women's Health Study. Cephalalgia 2011; 31:1106-15. [PMID: 21673005 DOI: 10.1177/0333102411412628] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Migraine with aura (MA) has been associated with increased risk of cardiovascular disease (CVD). The role of aspirin on this association remains unclear. METHODS Post-hoc subgroup analyses of the Women's Health Study, a randomized trial testing 100 mg aspirin on alternate days in primary prevention of CVD among 39,876 women aged ≥ 45. RESULTS During 10 years, 998 major CVD events were confirmed in 39,757 women with complete migraine information. Aspirin reduced risk of ischaemic stroke (relative risk, RR, 0.76, 95% CI 0.63-0.93) but not other CVD. Migraine or MA did not modify the effect of aspirin on CVD except for myocardial infarction (MI) (p for interaction = 0.01). Women with MA on aspirin had increased risk of MI (RR 3.72, 95% CI 1.39-9.95). Further exploratory analyses indicate that this increased risk is only apparent among women with MA on aspirin who ever smoked or had history of hypertension (p for interaction<0.01). CONCLUSIONS In post-hoc subgroup analyses, aspirin had similar protective effects on ischaemic stroke for women with or without migraine. By contrast, our data suggest that women with MA on aspirin had increased risk of MI. The small number of outcome events in subgroups, the exploratory nature of our analyses, and lack of plausible mechanisms raise the possibility of a chance finding, which must caution the interpretation.
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