Migraineurs may have more risk of hemorrhagic stroke
People with migraine may have an increased risk of hemorrhagic stroke, especially women younger than 45, a meta-analysis found.
People with migraine may have an increased risk of hemorrhagic stroke, especially women younger than 45, a meta-analysis found.
Researchers reviewed the literature through March 2013 for case-control and cohort studies with a clear definition of the diagnostic criteria for migraine and hemorrhagic stroke to find 8 studies (4 case-control and 4 cohort studies) involving a total of 1,600 hemorrhagic strokes.
Results appeared online Oct. 1 at Stroke.
The overall pooled adjusted effect estimate of hemorrhagic stroke in subjects with any migraine versus control subjects was 1.48 (95% CI, 1.16 to 1.88; P=0.002), with moderate statistical heterogeneity (I2=54.7%; P value for Q test=0.031). The increase in hemorrhagic stroke associated with migraine with aura (1.62; 95% CI, 0.87 to 3.03; P=0.129) was not significant.
Compared with control subjects, the risk of hemorrhagic stroke was greater in women with any migraine (1.55; 95% CI, 1.16 to 2.07; P=0.003), as well as female migraineurs under 45 years old (1.57; 95% CI, 1.10 to 2.24; P=0.012).
Researchers noted that only 2 studies reported data for men, so a direct comparison of the risk in women with the risk in men was not possible. The analysis could not determine the effects of migraines with or without aura because only 2 cohort studies and 1 case-control study collected data on the risk of hemorrhagic stroke according to migraine type. The group of patients who had migraines with aura was a smaller subgroup and the effect size estimate was higher than that for migraine without aura, so the meta-analysis may not have sufficient power to detect an association, the study authors noted. Also, an analysis based on only 8 studies may limit the conclusiveness of the results. Finally, the mechanisms underlying the association between migraine and hemorrhagic stroke are uncertain.
“Consequently, no alert should be given to migraineurs because no changes to their current standard treatments are needed,” the authors wrote. “Indeed, to date, the best recommendation for physicians treating subjects with migraine is to continue to focus carefully on those factors that could increase their risk of vascular events.”