BMJ 1995;310:830-833 (1 April)

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Case-control study of migraine and risk of ischaemic stroke in young women

Christophe Tzourio, clinical epidemiologist,a Alain Tehindrazanarivelo, senior registrar,b Serge Iglesias, registrar,b Annick Alperovitch, director of research,a Francois Chedru, head of department,c Jacques d'Anglejan-Chatillon, head of department,d Marie-Germaine Bousser, professor of neurology b

a INSERM U 360, Recherches Epidemiologiques en Neurologie et Psychopathologie, Cedex 94807 Villejuif, France, b Service de Neurologie, Hopital Saint-Antoine, Paris, France, c Service de Neurologie, Hopital de Meaux, France, d Service de Neurologie, Hopital de Versailles, France

Correspondence to: Dr Tzourio.

Abstract

Objective: To determine whether migraine is a risk factor for ischaemic stroke in young women.
Design: A case-control study.
Setting: Five hospitals in Paris and suburbs.
Subjects: 72 women aged under 45 with ischaemic stroke and 173 controls randomly selected from women hospitalised in the same centres.
Main outcome measures: Ischaemic stroke confirmed by cerebral computerised tomography or magnetic resonance imaging; history of headache recorded with structured interview, and diagnosis of migraine assessed by reproducibility study.
Results: Ischaemic stroke was strongly associated with migraine, both migraine without aura (odds ratio 3.0 (95% confidence interval 1.5 to 5.8)) and migraine with aura (odds ratio 6.2 (2.1 to 18.0)). The risk of ischaemic stroke was substantially increased for migrainous women who were using oral contraceptives (odds ratio 13.9) or who were heavy smokers (>/=20 cigarettes/day) (odds ratio 10.2).
Conclusions: These results indicate an independent association between migraine and the risk of ischaemic stroke in young women. Although the absolute risk of ischaemic stroke in young women with migraine is low, the reduction of known risk factors for stroke, in particular smoking and use of oral contraceptives, should be considered in this group.


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