Intended for healthcare professionals


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

BMJ 2009; 338 doi: (Published 11 March 2009) Cite this as: BMJ 2009;338:b664
  1. Cheryl D Bushnell, associate professor1,
  2. Margaret Jamison, statistician and head of program evaluations2,
  3. Andra H James, assistant professor3
  1. 1Department of Neurology, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
  2. 2University of North Carolina School of Medicine, Office of Educational Development, Chapel Hill, NC 27599-7530
  3. 3Division of Maternal Fetal-Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710
  1. Correspondence to: C D Bushnell cbushnel{at}
  • Accepted 2 December 2008


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.


  • Contributors: CDB and AHJ contributed to the conception and design of the study and to drafting the article, revising it critically for important intellectual content, and final approval of the version to be published. MJ contributed to the analysis and interpretation of data, as well as to drafting the article and the final approval of the version to be published. CDB is the guarantor.

  • Funding: The study was funded in part by the National Institutes of Health (5K12-HD043446-03 and K02-NS058760). The funding agency had no role in the conception or design of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript. The authors were independent from the funders in all aspects of the study design, analysis of data, and writing of the manuscript.

  • Competing interests: None declared.

  • Ethical approval: Not needed.

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.

View Full Text