Abstract
Dozens of observational studies and two meta-analyses have investigated the association of migraine with the risk of stroke, but their results are inconsistent. We aimed to quantitatively evaluate the relationship between migraine and stroke risk by performing a meta-analysis of prospective cohort studies. PubMed and Embase were searched through July 2016 to identify studies that met pre-stated inclusion criterion and reference lists of retrieved articles were also reviewed. Information on the characteristics of the included study, risk estimates, and control for possible confounding factors were extracted independently by two authors. The random-effects model was used to calculate the pooled risk estimates. Eleven prospective cohort studies involving 3371 patients with stroke and 2,221,888 participants were included in this systematic review. Compared with non-migraineurs, the pooled relative risks of total stroke, hemorrhagic stroke, and ischemic stroke for migraineurs were 1.55 [95% confidence interval (CI) 1.38–1.75], 1.15 (95% CI 0.85–1.56), and 1.64 (95% CI 1.22–2.20), respectively. Exception of any single study did not materially alter the combined risk estimate. Integrated epidemiological evidence supports that migraine should be associated with the increased risk of total stroke and ischemic stroke, but the relationship between migraine and the risk of hemorrhagic stroke is not of certainty.
Similar content being viewed by others
References
Elkind MS, Sacco RL (1998) Stroke risk factors and stroke prevention. Semin Neurol 18(4):429–440. doi:10.1055/s-2008-1040896
Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T (2009) Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 339:b3914. doi:10.1136/bmj.b3914
Sacco S, Kurth T (2014) Migraine and the risk for stroke and cardiovascular disease. Curr Cardiol Rep 16(9):524. doi:10.1007/s11886-014-0524-1
Spector JT, Kahn SR, Jones MR, Jayakumar M, Dalal D, Nazarian S (2010) Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med 123(7):612–624. doi:10.1016/j.amjmed.2009.12.021
Merikangas KR, Fenton BT, Cheng SH, Stolar MJ, Risch N (1997) Association between migraine and stroke in a large-scale epidemiological study of the United States. Arch Neurol 54(4):362–368
Velentgas P, Cole JA, Mo J, Sikes CR, Walker AM (2004) Severe vascular events in migraine patients. Headache 44(7):642–651. doi:10.1111/j.1526-4610.2004.04122.x
Sacco S, Ornello R, Ripa P, Pistoia F, Carolei A (2013) Migraine and hemorrhagic stroke: a meta-analysis. Stroke 44(11):3032–3038. doi:10.1161/STROKEAHA.113.002465
Buring JE, Hebert P, Romero J, Kittross A, Cook N, Manson J, Peto R, Hennekens C (1995) Migraine and subsequent risk of stroke in the Physicians’ Health Study. Arch Neurol 52(2):129–134
Hall GC, Brown MM, Mo J, MacRae KD (2004) Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice. Neurology 62(4):563–568
Kurth T, Slomke MA, Kase CS, Cook NR, Lee IM, Gaziano JM, Diener HC, Buring JE (2005) Migraine, headache, and the risk of stroke in women: a prospective study. Neurology 64(6):1020–1026. doi:10.1212/01.WNL.0000154528.21485.3A
Monteith TS, Gardener H, Rundek T, Elkind MS, Sacco RL (2015) Migraine and risk of stroke in older adults: Northern Manhattan Study. Neurology 85(8):715–721
Kurth T, Winter AC, Eliassen AH, Dushkes R, Mukamal KJ, Rimm EB, Willett WC, Manson JE, Rexrode KM (2016) Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ 353:i2610. doi:10.1136/bmj.i2610
Gelfand AA, Fullerton HJ, Jacobson A, Sidney S, Goadsby PJ, Kurth T, Pressman A (2015) Is migraine a risk factor for pediatric stroke? Cephalalgia 35(14):1252–1260
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269 (W264)
Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2012) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute. URL: http://www.ohrica/programs/clinical_epidemiology/oxfordhtm Accessed on 2
Greenland S (1987) Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 9:1–30
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. doi:10.1136/bmj.327.7414.557
Stang PE, Carson AP, Rose KM, Mo J, Ephross SA, Shahar E, Szklo M (2005) Headache, cerebrovascular symptoms, and stroke: the Atherosclerosis Risk in Communities Study. Neurology 64(9):1573–1577. doi:10.1212/01.WNL.0000158326.31368.04
Kurth T, Gaziano JM, Cook NR, Bubes V, Logroscino G, Diener HC, Buring JE (2007) Migraine and risk of cardiovascular disease in men. Arch Intern Med 167(8):795–801. doi:10.1001/archinte.167.8.795
Kurth T, Kase CS, Schurks M, Tzourio C, Buring JE (2010) Migraine and risk of haemorrhagic stroke in women: prospective cohort study. BMJ 341:c3659. doi:10.1136/bmj.c3659
Sacco S, Ornello R, Ripa P, Tiseo C, Degan D, Pistoia F, Carolei A (2015) Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies. Eur J Neurol 22(6):1001–1011
Pizza V, Bisogno A, Lamaida E, Agresta A, Bandieramonte G, Volpe A, Galasso R, Galasso L, Caputo M, Tecce MF (2010) Migraine and coronary artery disease: an open study on the genetic polymorphism of the 5, 10 methylenetetrahydrofolate (MTHFR) and angiotensin I-converting enzyme (ACE) genes. Cent Nerv Syst Agents Med Chem 10(2):91–96
D’Andrea G, Hasselmark L, Alecci M, Cananzi A, Perini F, Welch KM (1994) Platelet secretion from dense and alpha-granules in vitro in migraine with or without aura. J Neurol Neurosurg Psychiatry 57(5):557–561
Elliott D (2008) Migraine and stroke: current perspectives. Neurol Res 30(8):801–812. doi:10.1179/174313208X341049
Zeller JA, Frahm K, Baron R, Stingele R, Deuschl G (2004) Platelet-leukocyte interaction and platelet activation in migraine: a link to ischemic stroke? J Neurol Neurosurg Psychiatry 75(7):984–987
Lee ST, Chu K, Jung KH, Kim DH, Kim EH, Choe VN, Kim JH, Im WS, Kang L, Park JE, Park HJ, Park HK, Song EC, Lee SK, Kim M, Roh JK (2008) Decreased number and function of endothelial progenitor cells in patients with migraine. Neurology 70(17):1510–1517. doi:10.1212/01.wnl.0000294329.93565.94
Borgdorff P, Tangelder GJ (2012) Migraine: possible role of shear-induced platelet aggregation with serotonin release. Headache 52(8):1298–1318. doi:10.1111/j.1526-4610.2012.02162.x
Harriott AM, Barrett KM (2015) Dissecting the Association Between Migraine and Stroke. Curr Neurol Neurosci Rep 15(3):1–14
Del ZE, Pezzini A, Giossi A, Volonghi I, Padovani A (2008) Migraine and ischemic stroke: a debated question. J Cereb Blood Flow Metab 28(8):1399–1421
Sacco S, Olivieri L, Bastianello S, Carolei A (2006) Comorbid neuropathologies in migraine. J Headache Pain 7(4):222–230. doi:10.1007/s10194-006-0300-8
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We declare we have no conflict of interest. No funding is received for this systematic review.
Additional information
X. Hu and Y. Zhou contributed equally to this work.
Rights and permissions
About this article
Cite this article
Hu, X., Zhou, Y., Zhao, H. et al. Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies. Neurol Sci 38, 33–40 (2017). https://doi.org/10.1007/s10072-016-2746-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-016-2746-z