Late Onset of Migraine With Aura Linked to Ischemic Stroke

Previous research has tied prevalence of migraine, especially migraine with aura (MA), to an increased risk of stroke. Now, a new study is highlighting the importance of age of migraine onset, finding that patients who experience late onset MA may be at an increased risk of iscehmic stroke in late life despite having a shorter history of MA.

Meanwhile, according to the study findings, patients who had had early onset of migraine were not observed as having an increased risk.

The findings come from an analysis of the Atherosclerosis Risk in Communities Study, which included 11,592 patients, 447 of which had MA and 1128 had migraine without aura. Participants recorded their migraine history between 1993 and 1995 and were then followed for ischemic stroke incidence over 20 years.

“Understanding of the association between the age of onset of migraine and ischemic stroke in late life may shed light on the effect of migraine on cerebrovascular disease,” explained the researchers.

The mean age of these patients was 37 and over the study period, 86 (5.26%) had an ischemic stroke event. While the incidence rate of stroke among patients with MA with age of onset at or older than 50 was 6.67 per 1000 person years, the incident rate was less than half that among patients with MA with age of onset before 50 (3.04 per 1000 person years).

Comparing patients with MA to patients with no headache, the researchers found that there was a significant association between MA starting at or after age 50 and ischemic stroke. Meanwhile, MA beginning before age 50 was not associated with stroke risk when modeled against patients with no headache.

“Taken together, these results suggest that increased stroke risk may not be related to recurrent MA attacks over longer periods, despite the associated aberrant functional and microstructural changes in brain regions,” wrote the researchers. “Given that no significant atherosclerosis burden in migraineurs was found when compared nonmigraineurs, it is unlikely atherosclerosis plays an important role in the shared mechanism between MA and stroke.”

Notably, migraine without aura was not associated with ischemic stroke regardless of the age of onset.

Reference:

Androulakis X, Sen S, Kodumuri N, et al. Migraine age of onset and association with ischemic stroke in late life: 20 years follow-up in ARIC [published online January 21, 2019]. Headache. doi: 10.1111/head.13468.