Nicolas Martinez-Majander1, Ville Artto1, Pauli Ylikotila2, Bettina von Sarnowski3, Ulrike Waje-Andreassen4, Nilufer Yesilot5, Marialuisa Zedde6, Juha Huhtakangas7, Heikki Numminen8, Pekka Jäkälä9, Ana C Fonseca10, Petra Redfors11,12, Marieke J H Wermer13, Alessandro Pezzini14, Jukka Putaala1. 1. Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland. 2. Neurocenter, Turku University Hospital, Clinical Neurosciences, Turku University, Turku, Finland. 3. Department of Neurology, University Medicine Greifswald, Greifswald, Germany. 4. Department of Neurology, Haukeland University Hospital, Bergen, Norway. 5. Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey. 6. Neurology Unit, Company Local Health Unit-Reggio Emilia National Institute for Research and Treatment, Reggio Emilia, Italy. 7. Department of Neurology, Oulu University Hospital, Oulu, Finland. 8. Department of Neuroscience and Rehabilitation, Tampere University Hospital, Tampere, Finland. 9. Kuopio University Hospital, Neurocenter Neurology, Finland and University of Eastern Finland, Kuopio, Finland. 10. Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal. 11. Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 12. Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. 13. Leiden University Medical Center, Leiden, the Netherlands. 14. Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy.
Abstract
OBJECTIVE: To assess the association between migraine and cryptogenic ischemic stroke (CIS) in young adults, with subgroup analyses stratified by sex and presence of patent foramen ovale (PFO). METHODS: We prospectively enrolled 347 consecutive patients aged 18 to 49 years with a recent CIS and 347 age- and sex-matched (±5 years) stroke-free controls. Any migraine and migraine with (MA) and migraine without aura (MO) were identified by a screener, which we validated against a headache neurologist. We used conditional logistic regression adjusting for age, education, hypertension, diabetes, waist-to-hip ratio, physical inactivity, current smoking, heavy drinking, and oral estrogen use to assess independent association between migraine and CIS. The effect of PFO on the association between migraine and CIS was analyzed with logistic regression in a subgroup investigated with transcranial Doppler bubble screen. RESULTS: The screener performance was excellent (Cohen kappa > 0.75) in patients and controls. Compared with nonmigraineurs, any migraine (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.63-3.76) and MA (OR = 3.50, 95% CI = 2.19-5.61) were associated with CIS, whereas MO was not. The association emerged in both women (OR = 2.97 for any migraine, 95% CI = 1.61-5.47; OR = 4.32 for MA, 95% CI = 2.16-8.65) and men (OR = 2.47 for any migraine, 95% CI = 1.32-4.61; OR = 3.61 for MA, 95% CI = 1.75-7.45). Specifically for MA, the association with CIS remained significant irrespective of PFO. MA prevalence increased with increasing magnitude of the right-to-left shunt in patients with PFO. INTERPRETATION: MA has a strong association with CIS in young patients, independent of vascular risk factors and presence of PFO. ANN NEUROL 2021;89:242-253.
OBJECTIVE: To assess the association between migraine and cryptogenic ischemic stroke (CIS) in young adults, with subgroup analyses stratified by sex and presence of patent foramen ovale (PFO). METHODS: We prospectively enrolled 347 consecutive patients aged 18 to 49 years with a recent CIS and 347 age- and sex-matched (±5 years) stroke-free controls. Any migraine and migraine with (MA) and migraine without aura (MO) were identified by a screener, which we validated against a headache neurologist. We used conditional logistic regression adjusting for age, education, hypertension, diabetes, waist-to-hip ratio, physical inactivity, current smoking, heavy drinking, and oral estrogen use to assess independent association between migraine and CIS. The effect of PFO on the association between migraine and CIS was analyzed with logistic regression in a subgroup investigated with transcranial Doppler bubble screen. RESULTS: The screener performance was excellent (Cohen kappa > 0.75) in patients and controls. Compared with nonmigraineurs, any migraine (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.63-3.76) and MA (OR = 3.50, 95% CI = 2.19-5.61) were associated with CIS, whereas MO was not. The association emerged in both women (OR = 2.97 for any migraine, 95% CI = 1.61-5.47; OR = 4.32 for MA, 95% CI = 2.16-8.65) and men (OR = 2.47 for any migraine, 95% CI = 1.32-4.61; OR = 3.61 for MA, 95% CI = 1.75-7.45). Specifically for MA, the association with CIS remained significant irrespective of PFO. MA prevalence increased with increasing magnitude of the right-to-left shunt in patients with PFO. INTERPRETATION: MA has a strong association with CIS in young patients, independent of vascular risk factors and presence of PFO. ANN NEUROL 2021;89:242-253.
Authors: Adrian Scutelnic; Lukas A Kreis; Morin Beyeler; Mirjam R Heldner; Thomas R Meinel; Johannes Kaesmacher; Arsany Hakim; Marcel Arnold; Urs Fischer; Heinrich P Mattle; Christoph J Schankin; Simon Jung Journal: Front Neurol Date: 2022-09-14 Impact factor: 4.086