Migraine and Stroke: Is There a Link?
What are migraines and how common are they?
Have you ever experienced a migraine or know someone with a migraine? Then you are not alone! Migraine is a common neurological condition that affects millions of people worldwide. It is characterized by severe, throbbing pain in the head, usually accompanied by other symptoms such as nausea and sensitivity to light and sound, other physical and psychological signs and symptoms. Migraine has a heavy burden on individuals and society. In fact, it is the second most disabling neurological condition in the world.
Is there a link between migraines and stroke also in elderly?
Recently, there has been growing concern about the link between migraines and the risk of cardiovascular disease, including stroke. A serious and potentially life-threatening condition that occurs when blood flow to the brain is disrupted. While research has shown that younger migraine sufferers may have a higher risk of stroke, it has been unclear whether this association holds true for older individuals. In a recent study, we sought to shed more light on this topic.
Our study
The research was conducted within the Rotterdam Study, a large population-based study that has been ongoing since 1990. We included 6925 stroke-free participants with a mean age of 65.7 (min 45 — max 98) years. Participants in the study were assessed for the presence of migraine using a validated questionnaire between 2006 and 2011. Stroke history was determined at baseline by a physician and verified through medical records. Participants were then continuously monitored for new strokes up to 10 years. We used statistical models that controlled for age, sex, and other factors.
What we found?
At the beginning, 14.9% of our participants reported a lifetime history of migraines. During the follow-up, 195 participants developed a stroke. 163 of these cases were ischemic strokes (caused by a blockage in a blood vessel supplying the brain). Statistical analyses showed that there was a slightly higher risk of stroke among individuals with a history of migraines, although this association was not statistically significant. In other words, we did not find conclusive evidence that migraines increase the risk of stroke in older adults.
We did not find conclusive evidence that migraines increase the risk of stroke in older adults.
Previous studies have reported conflicting results on this topic, with some finding an increased risk of stroke among older adults with migraines and others finding no link. One possible explanation for these conflicting results is that migraine was diagnosed based on medical files, which may not be representative of all migraine patients in the population. By contrast, we approached all the potential participants in a specific region, and used a validated questionnaire to identify people with migraine who had not yet visited a healthcare professional.
Our study has other strengths, including its prospective design, following the participants for new strokes for a long time and using a validated questionnaire. However, there are also some limitations that should be considered when interpreting our results. For example, our study may have missed a link that is actually there due to the relatively low number of stroke events, and the criteria used for migraine assessment were slightly modified from the standard criteria. Furthermore, we did not have information on headache intensity or headaches other than migraines, which could have led to mistaking the migraine patients with less severe headache intensity as non-migraineurs.
What should people with migraines be aware of in terms of stroke risk?
Despite the findings of this study, it is still important for individuals with migraines to be aware of their potential risk for stroke. While there is no clear evidence to suggest that migraines increase the risk of stroke in older adults, other risk factors such as smoking, high blood pressure, and high cholesterol should still be addressed to reduce the risk of stroke. Future research should continue to investigate the relationship between migraines and stroke, especially in younger populations and around the time of migraine onset.
While there is no clear evidence to suggest that migraines increase the risk of stroke in older adults, other risk factors such as smoking, high blood pressure, and high cholesterol should still be addressed to reduce the risk of stroke.
In conclusion, our findings underscore the importance of identifying migraine patients who may be at higher risk of stroke and providing them with appropriate care and management.
Source: Acarsoy C, Fani L, Al-Hassany L, et al. Migraine and the risk of stroke in a middle-aged and elderly population: A prospective cohort study. Cephalalgia. 2023;43(1). doi:10.1177/03331024221132008
