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Migraine with Aura Doubles Ischemic Stroke Rate

People who have migraine with aura are more likely to have strokes caused by either a blood clot in the heart or a clot within the brain’s blood vessels compared to those who have migraine without aura,  a new study indicates.

24964721940_3d1e8792f8_bThis research builds on previous studies regarding stroke and migraine, which has shown a higher rate of stroke among older migraineurs who smoke and women younger than 45, particularly if they smoke, have high blood pressure, or use oral contraceptives.

In this 25-year ongoing study of nearly 13,000 adults ages 45 to 64, researchers found that 817 participants had ischemic strokes—strokes that occur when a clot or a mass clogs a blood vessel, cutting off blood flow to brain cells.

When they compared migraine with aura patients to those who had migraine without aura, researchers found:

  • Migraine with aura patients were 2.4 times more likely to have an ischemic stroke.
  • Migraine with aura patients were 3 times more likely to have an ischemic stroke caused by a mass or a clot that forms in the heart, dislodges, and travels to the brain (cardio-embolic stroke).
  • Migraine with aura patients were twice as likely to have an ischemic stroke caused by a clot that develops in a clogged part of the blood vessel supplying blood to the brain (thrombotic stroke).

Souvik Sen, MD, MPH, study author and a neurologist at the University of South Carolina School of Medicine in Columbia, SC, provided a possible explanation for the findings: Because migraines alter the blood vessels in the brain, the greater incidence of strokes caused by clots in the heart or the brain’s blood vessels suggests that migraine also affects blood vessels in the heart and neck.

“If we are going to prevent people with migraines with aura from having a stroke, it’s important to know what types of stroke they’re having and then be vigilant about it,” Dr. Sen said.

This study, and previous studies linking migraine with stroke, have implications for medical care.

“If you get migraines with aura, make sure your stroke risk factors are assessed by your doctor,” Dr. Sen said. Stroke risk factors, including high blood pressure, diabetes, smoking, and high cholesterol, need to be treated. People with migraine and a stroke should be screened for hardening of blood vessels and irregular heartbeat—two factors linked to the mechanisms that cause cardio-embolic and thrombotic ischemic strokes.

The study has not yet been published, but was presented at the American Stroke Association’s International Stroke Conference 2016 in February in Los Angeles, CA.

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