Migraine linked to spontaneous cervical artery dissection
medwireNews: IPSYS investigators have found a significant association between migraine and cervical artery dissection (CEAD), identifying it as a potential biomarker.
“This association persisted after adjustment for traditional vascular risk factors, and it was apparent for the migraine subtype without aura more than for migraine with aura, for men more than for women, and for the younger rather than the older age group,” note study author Alessandro Pezzini (Università degli Studi di Bresica, Italy) and colleagues.
The team identified 2485 individuals aged 18 to 45 years with a first-ever acute ischemic stroke enrolled in the IPSYS (Italian Project on Stoke in Young Adults) registry. Of these, 334 (13.4%) had CEAD ischemic stroke.
Patients in this group were significantly more likely to have migraine, at a rate of 30.8% versus 24.4% for the 2151 (86.6%) of individuals with non-CEAD ischemic stroke.
The difference was primarily due to migraine without aura, which was present in 24.0% of patients with CEAD ischemic stroke, compared with 15.6% of those with non-CEAD ischemic stroke. This migraine subtype was significantly associated with a 1.74-fold increased risk for CEAD ischemic stroke, whereas there was no significant association for the migraine with aura subtype.
The findings, published in JAMA Neurology, also showed that the association between migraine without aura and CEAD ischemic stroke was stronger for men than women (odds ratio [OR]=1.99 vs 1.53) and for those aged 39 years and younger versus older patients (OR=1.82 vs 1.55).
Patients with migraine were more likely to have patent foramen ovale than those without but the association between migraine category and CEAD did not change after adjusting for this factor and other confounding variables, such as hypertension, diabetes, smoking, or hypercholesterolemia.
The team says that there are “convincing arguments” that common biologic pathways underlie both migraine and CEAD ischemic stroke.
“Among these, shared genetic susceptibility and endothelial dysfunction seem to be plausible,” they speculate, whereas the possibility of an increased propensity to develop CEAD in people with migraine “seems unlikely.”
But in a related editorial, Patrick Lyden (Cedars-Sinai Medical Center, Los Angeles, California, USA) says: “The true value of the IPSYS finding […] is not in the speculation, but in the strength of the association: the population study is large, and the result is robust.”
While the risk of CEAD was mainly driven by the migraine without aura subtype, the researchers note that a lack of objective markers makes it difficult to correctly identify migraine phenotype.
They therefore conclude: “Our data support consideration of a history of migraine as a marker for increased risk of [ischemic stroke] caused by CEAD, as well as putative susceptibility factor for CEAD, regardless of its clinical features.”
Lyden agrees: “Counseling people with migraine about activities that are likely to lead to cervical arterial dissection seems simple enough, and apparently is likely to help reduce stroke in this working-age population.”
By Lucy Piper
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2017