Research

Migraine and risk of haemorrhagic stroke in women: prospective cohort study

BMJ 2010; 341 doi: 10.1136/bmj.c3659 (Published 24 August 2010)
Cite this as: BMJ 2010;341:c3659
  1. Tobias Kurth, director of research1234,
  2. Carlos S Kase, professor of neurology5,
  3. Markus Schürks, instructor of medicine1,
  4. Christophe Tzourio, director of research23,
  5. Julie E Buring, professor of medicine and epidemiology146
  1. 1Divisions of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  2. 2INSERM Unit 708-Neuroepidemiology, Paris, France
  3. 3UPMC Univ Paris 06, F-75005, Paris, France
  4. 4Department of Epidemiology, Harvard School of Public Health, Boston, MA
  5. 5Department of Neurology, Boston University School of Medicine, Boston, MA
  6. 6Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA
  1. Correspondence to: T Kurth, INSERM Unit 708-Neuroepidemiology, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France tkurth{at}rics.bwh.harvard.edu
  • Accepted 17 May 2010

Abstract

Objectives To examine the association between migraine and migraine aura status with risk of haemorrhagic stroke.

Design Prospective cohort study.

Setting Women’s Health Study, United States.

Participants 27 860 women aged ≥45 who were free from stroke or other major disease at baseline and had provided information on self reported migraine, aura status, and lipid values.

Main outcome measures Time to first haemorrhagic stroke and subtypes of haemorrhagic stroke.

Results At baseline, 5130 (18%) women reported any history of migraine; of the 3612 with active migraine (migraine in the previous year), 1435 (40%) described having aura. During a mean of 13.6 years of follow-up, 85 haemorrhagic strokes were confirmed after review of medical records. Compared with women without a history of migraine, there was no increased risk of haemorrhagic stroke in those who reported any history of migraine (adjusted hazard ratio 0.98, 95% confidence interval 0.56 to 1.71, P=0.93). In contrast, risk was increased in women with active migraine with aura (2.25, 1.11 to 4.54, P=0.024). The age adjusted increased risk was stronger for intracerebral haemorrhage (2.78, 1.09 to 7.07, P=0.032) and for fatal events (3.56, 1.23 to 10.31, P=0.02). Four additional haemorrhagic stroke events were attributable to migraine with aura per 10 000 women per year. Women who reported active migraine without aura had no increased risk for haemorrhagic stroke.

Conclusion Migraine with aura might, in addition to ischaemic events, also be a risk factor for haemorrhagic stroke. The relatively low number of events and attributable risk should caution against definitive conclusions and call for further confirmation of these observations.

Footnotes

  • We thank the participants in the Women’s Health Study for their outstanding commitment and cooperation and the entire staff of the Women’s Health Study for their expert and unfailing assistance.

  • Contributors: TK conceived and designed the study, analysed the data, and drafted the manuscript. CSK and JEB were responsible for the acquisition of the data. All authors interpreted the data, critically revised the draft for important intellectual content, and gave final approval of the version to be published. TK is guarantor.

  • Funding: The Women’s Health Study is supported by grants from the National Heart, Lung, and Blood Institute (HL-043851 and HL-080467), and the National Cancer Institute (CA-47988). The research for this work was supported by grants from the Donald W Reynolds Foundation, the Leducq Foundation, and the Doris Duke Charitable Foundation. The sponsors of the study played no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: TK has received investigator initiated research funding from the French National Research Agency, the National Institutes of Health, Merck, and the Migraine Research Foundation. He is a consultant to i3 Drug Safety and World Health Information Science Consultants, LLC (www.whiscon.com), and has received honorariums from Genzyme, Merck, and Pfizer for educational lectures. CK has received honorariums as a consultant for Sanofi-Aventis. MS has received investigator initiated research funds from the Migraine Research Foundation and honorariums from LEK. CT has received investigator initiated research funding from the French National Research Agency and received fees from Sanofi-Synthelabo for participating in a data safety monitoring board and from Merck Sharp & Dohme and the Servier company for participating in scientific committees. JEB has received investigator initiated research funding and support from the National Institutes of Health and Dow Corning Corporation and research support for pills and/or packaging from Bayer Heath Care and the Natural Source Vitamin E Association.

  • Ethical approval: This study was approved by the Institutional Review Board of Brigham and Women’s Hospital, Boston, MA, and all participants provided written informed consent.

  • Data sharing: No additional data available.

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This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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