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Migraine-related ischemic stroke uncommon in older patients

NEW YORK (Reuters Health) – The typical patient with ischemic stroke and migraine is a female under the age of 45, according to results of an analysis of ischemic stroke patients with and without active migraine from a large prospective stroke registry.

A research team led by Dr. Didier Milhaud from CHUV, Lausanne, Switzerland separated the migrainous patients in the registry into two age groups: those under age 45 and those ages 45 and older. A group of patients with ischemic stroke but without migraine served as controls.

According to the team, 130 (3.7%) of the 3502 ischemic stroke patients had active migraine. These cases represented 15.8% of all subjects in the younger age group and 2.1% of the older subjects.

Significant sex differences emerged, the team reports. Migraine occurred roughly three times more often in women than in men in both age groups. Younger women with ischemic stroke had a higher prevalence of oral contraceptive use and "multivariate analysis showed that this factor was characteristic of migraine," the researchers note in the November 27th issue of the journal Neurology.

In the younger migrainous group, ischemic stroke developed in 9 patients during an attack of migraine with aura and in 15 during an attack of migraine without aura. The presence of a patent foramen ovale was characteristic of young patients with ischemic stroke and migraine, and posterior circulation involvement emerged as a "significant predictor" of migraine in multivariate analyses.

"Surprisingly," Dr. Milhaud's team says, known vascular risk factors such as hypertension, ischemic heart disease and cigarette smoking, were absent in older migrainous patients with ischemic stroke. "This result suggests that, contrary to a classic point of view, the risk of ischemic stroke does not necessarily increase when migraine is associated with other vascular risk factors," they write.

Neurology 2001;57:1805-1811.

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