Published 10 March 2009, doi:10.1136/bmj.b664
Cite this as: BMJ 2009;338:b664

Research

Migraines during pregnancy linked to stroke and vascular diseases: US population based case-control study

¹ Department of Neurology, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA, ² University of North Carolina School of Medicine, Office of Educational Development, Chapel Hill, NC 27599-7530 jamisonm@earthlink.net, ³ Division of Maternal Fetal-Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710 Andra.james@duke.edu

Objective To examine the association between migraine and cardiovascular diseases during pregnancy.

Design US population based case-control study.

Setting Nationwide inpatient sample, from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality.

Population 18 345 538 pregnancy related discharges from 2000 to 2003.

Main outcome measures Diagnosis of migraine, as identified by ICD-9 codes 346.0 and 346.1. Stroke and other vascular diseases were identified by using standard ICD-9 codes.

Results From the hospital discharges with a pregnancy discharge code, 33 956 migraine codes were identified: 185 per 100 000 deliveries. Diagnoses that were jointly associated with migraine codes during pregnancy (excluding pre-eclampsia) were stroke (odds ratio 15.05, 95% confidence interval 8.26 to 27.4), myocardial infarction/heart disease (2.11, 1.76 to 2.54), pulmonary embolus/venous thromboembolism (3.23, 2.06 to 7.07), and hypertension (8.61, 6.43 to 11.54), as well as pre-eclampsia/gestational hypertension (2.29, 2.13 to 2.46), smoking (2.85, 2.53 to 3.21), and diabetes (1.96, 1.64 to 2.35). However, migraine was not associated with several non-vascular diagnoses (pneumonia, transfusions, postpartum infection or haemorrhage).

Conclusions In this large, population based sample of pregnant women admitted to hospital, a strong relation existed between active peripartum migraine and vascular diagnoses during pregnancy. Because these data do not allow determination of which came first, migraine or the vascular condition, prospective studies of pregnant women are needed to explore this association further.

© Bushnell et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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This article has been cited by other articles:

• (2009). Pregnancy-Associated Migraines Linked to Stroke. JWatch Women's Health 2009: 1-1 [Full text]  

Rapid Responses:

Read all Rapid Responses

Migraine and stroke

Rizaldy Pinzon
bmj.com, 13 Mar 2009 [Full text]

Deeply flawed data

Alexander Mauskop
bmj.com, 18 Mar 2009 [Full text]

Increased blood viscosity links migraines to stroke and myocardial infarction.

Les O. Simpson
bmj.com, 7 Apr 2009 [Full text]

Re: Deeply flawed data

Cheryl D Bushnell
bmj.com, 7 Apr 2009 [Full text]

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