Mirgaines and Stroke Risk for Women

Summary
Migraine is a common headache disorder in women affecting approximately 18 percent of females in their lifetime. One-third of migraine sufferers experience migraine “aura” or visual disturbance. This specific type of migraine with other neurological symptoms (migraine with aura), has previously been linked to strokes. The authors of this study evaluated a large group of females and showed that having migraines with aura can more than double the risk of stroke in women, without affecting the recovery following the stroke.

Introduction
Strokes are a leading cause of disability and death in the U.S. and globally as well. A link between migraines and strokes, especially in females, has been highlighted in some previous studies. However, results from previous studies have been unconvincing and the mechanism underlying this association is not clear. Also, no previous study has analyzed whether migraine affects the prognosis, or extent of recovery, following a stroke. Women have a three to four times higher likelihood of suffering from migraines and are more prone to disability after a stroke than men. This study analyzed a large group of women, in an attempt to know whether there was any association between migraines and prognosis following a stroke.

Methodology
•    Data from the Women’s Health Study was utilized, which included the records of 27,852 females aged 45 years or older.
•    Questionnaires were used to assess the medical history, including migraines, at the start of the study.
•    Thereafter, yearly questionnaires were used to note occurrences of a stroke (or mini-stroke) over an average period of 13.5 years. Recovery following such events was analyzed using standardized scales.
•    The occurrence of strokes, and recovery following a stroke, were analyzed in relation to migraines with aura.

Results
•    Approximately 18 percent of the women reported migraine, of which almost 40 percent had migraine with aura.
•    Women, who had a past history of migraines or those who suffered migraines without aura, did not have a substantially increased risk of mini-strokes or strokes.
•    The risk of a mini-stroke or stroke in women who had migraines with aura was 1.5 to 1.6 times greater than in those without migraines.
•    No effect of migraine was observed on the outcomes after a stroke.

Shortcomings/next steps
The occurrence of migraines (with/without aura) may have been wrongly estimated due to a “self-report” method. The use of medications that may have a bearing on strokes, like ergots, was also not noted. The study did not analyze the cost effect of strokes, which includes the length of hospital stay. Recovery following a stroke was determined at variable times, and may have affected the results. Future studies need to assess the effect of other risk factors (like clotting blood disorders), medication and duration of headache in relation to migraines and strokes.

Conclusion
This study shows that migraines with aura increase the risk of stroke in women aged 45 or older, without having any significant impact on recovery. Still, women suffering from migraines with aura do not seem to be at a higher “risk of a more unfavorable functional outcome after ischemic stroke.” However, considering the significant physical and social impact of having a stroke, women who suffer from migraines with aura should be cautious. In women reporting migraines with aura, all attempts must be made to control and also effectively manage other risk factors for stroke, like high blood pressure, diabetes, high cholesterol and obesity.

For More Information:
Migraine with Aura Is a Risk Factor for Stroke in Women but Does Not Affect Recovery
Publication Journal: Circulation, December 2010
By Pamela M. Rist; Julie E. Buring; Brigham and Women’s Hospital, Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts

*FYI Living Lab Reports Are Summaries of the Original Research.
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