By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.

SOURCE: Androulakis XM, Kodumuri N, Giamberardino LD, et al. Ischemic stroke subtypes and migraine with aura in the ARIC study. Neurology 2016;87:2527-2532.

The Atherosclerosis Risk in Communities study (ARIC) is a prospective, longitudinal community-based cohort study that started in 1993, and followed all vascular events including stroke for the subsequent 20 years. At time of enrollment, patients had to be in the age group of 45-64 years, and the mean age of the patients was 59 years at the third clinical visit of follow-up. All strokes are classified as either cardioembolic, lacunar, or thrombotic. Of 12,758 participants, there were 1,622 migraineurs. When compared to non-headache patients, there was a significant association between those patients who had migraine with visual aura and ischemic stroke, with a hazard ratio (HR) = 1.7 (95% confidence interval [CI], 1.2-2.6; P = 0.008). Migraine without visual aura was not significantly associated with ischemic stroke compared to non-headache participants. Among the three stroke types categorized in this study, migraine with visual aura was significantly associated only with cardioembolic stroke (HR, 3.7; 95% CI, 1.6-8.7; P = 0.003). The relationship between migraine and stroke is controversial, and findings vary across different population studies. This study shows a strong association between cardioembolic ischemic stroke and migraine with visual aura, but it does not explain the pathophysiology and mechanism for this association. It is proposed by the authors that migraine may predispose to atrial fibrillation, but this is a purely speculative mechanism.