Hemiplegic Migraine - ? An independent risk factor for stroke
I note Etminan et al's meta-analysis of observational studies suggesting that migraine with or without aura may be an independent risk factor for ischaemic stroke, and Thomas's editorial about the shortcomings of such studies and systemic reviews(1,2). In our acute stroke unit admitting over three hundred suspected acute stroke cases over a period of one year (January - December 2004), there were two cases of hemiplegic migraine (both with aura) - one familial and the other sporadic type. The familial one was a seventy year old woman who was admitted with left sided weakness, slurred speech and headache. She has had headache since a teenager, and continues to get attacks several times a week even as an older person but not always associated with hemiplegia. However, over the last ten years or so, she had at least four attacks of hemiplegic migraine requiring hospital admission - and on each occasion there was no clinical or imaging evidence of stroke, and the recovery was near complete after several days as one would expect in this situation.
The second (sporadic) case was that of a twenty five year old pregnant woman in her mid-trimester who also had left hemiplegia and facial drooping associated with migraine. This lasted for about a week with good recovery. She has had similar attacks in 1999 and twice in 2004. Again there was little clinical or imaging evidence of new or old stroke. Although these are only two cases, given the relatively long follow-up, one has to be justifiably cautious about the validity of the conclusion drawn from the meta-analysis for observational studies.
1.Etminan M et al. Risk of ischaemic stroke in people with migraine: systemic reviews and meta-analysis of observational studies. BMJ 2005;330:63-5.
2.Thomas D J. Migraine and ischaemic attack. BMJ 2005;330:54-5.
Both patients have given signed informed consent to publication of their case details.
Competing interests: No competing interests