BMJ 1999;318:13-18 ( 2 January )

Papers

Migraine and stroke in young women: case-control study

C L Chang, research fellow, a Michael Donaghy, reader, b Neil Poulter, professor, a World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. 

a Cardiovascular Studies Unit, Department of Clinical Pharmacology, Imperial College School of Medicine, London W2 1PG, b Department of Clinical Neurology, Radcliffe Infirmary, Oxford OX2 6HE

Correspondence to: Professor Poulter n.poulter{at}ic.ac.uk

Objective: To investigate the association between migraine and ischaemic or haemorrhagic stroke in young women.
Design: Hospital based case-control study.
Setting: Five European centres participating in the World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.
Subjects: 291 women aged 20-44 years with ischaemic, haemorrhagic, or unclassified arterial stroke compared with 736 age and hospital matched controls.
Intervention: Questionnaire.
Main outcome measure: Self reported history of headaches.
Results: Adjusted odds ratios associated with a personal history of migraine were 1.78 (95% confidence intervals, 1.14 to 2.77), 3.54 (1.30 to 9.61), and 1.10 (0.63 to 1.94) for all stroke, ischaemic stroke, and haemorrhagic stroke respectively. Odds ratios for ischaemic stroke were similar for classical migraine (with aura) (3.81, 1.26 to 11.5) and simple migraine (without aura) (2.97, 0.66 to 13.5). A family history of migraine, irrespective of personal history, was also associated with increased odds ratios, not only for ischaemic stroke but also haemorrhagic stroke. In migrainous women, coexistent use of oral contraceptives or a history of high blood pressure or smoking had greater than multiplicative effects on the odds ratios for ischaemic stroke associated with migraine alone. Change in the frequency or type of migraine on using oral contraceptives did not predict subsequent stroke. Between 20% and 40% of strokes in women with migraine seemed to develop directly from a migraine attack.
Conclusions: Migraine in women of childbearing age significantly increases the risk of ischaemic but not haemorrhagic stroke. The coexistence of oral contraceptive use, high blood pressure, or smoking seems to exert a greater than multiplicative effect on the risk of ischaemic stroke associated with migraine.

Key messages

  • A personal history of migraine was associated with increased risk of ischaemic but not haemorrhagic stroke

  • Coexistence of risk factors---use of oral contraceptives, high blood pressure, or smoking had more than multiplicative effects on odds ratios for ischaemic stroke associated with migraine alone

  • A family history of migraine, irrespective of a personal migraine history, was associated with increased risk of ischaemic and haemorrhagic stroke

  • Up to 40% of strokes in migrainous women develop directly out of a migraine attack---so called migrainous strokes

  • A change in type or frequency of migraine with use of oral contraceptives did not predict subsequent stroke




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Rapid Responses:

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R C Peatfield
bmj.com, 20 Jan 1999 [Full text]
Absolute risks need to be considered
Joanna Cais
bmj.com, 21 Jan 1999 [Full text]
Migraine and stroke in older women
M J Campbell
bmj.com, 17 Feb 1999 [Full text]
Migraine and ischaemic stroke
E Anne MacGregor
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