Skip to main content

Advertisement

Log in

Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies

  • Review Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Elkind MS, Sacco RL (1998) Stroke risk factors and stroke prevention. Semin Neurol 18(4):429–440. doi:10.1055/s-2008-1040896

    Article  CAS  PubMed  Google Scholar 

  2. 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

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  CAS  PubMed  Google Scholar 

  9. 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

    Article  CAS  PubMed  Google Scholar 

  10. 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

    Article  CAS  PubMed  Google Scholar 

  11. 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

    Article  PubMed  PubMed Central  Google Scholar 

  12. 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

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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

    Article  CAS  PubMed  Google Scholar 

  15. 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)

    Article  PubMed  Google Scholar 

  16. 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

  17. Greenland S (1987) Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 9:1–30

    CAS  PubMed  Google Scholar 

  18. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  PubMed  Google Scholar 

  19. 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

    Article  PubMed  PubMed Central  Google Scholar 

  20. 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

    Article  CAS  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  PubMed Central  Google Scholar 

  23. 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

    Article  CAS  PubMed  Google Scholar 

  24. 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

    Article  CAS  PubMed  Google Scholar 

  25. 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

    Article  PubMed  PubMed Central  Google Scholar 

  26. Elliott D (2008) Migraine and stroke: current perspectives. Neurol Res 30(8):801–812. doi:10.1179/174313208X341049

    Article  PubMed  Google Scholar 

  27. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    Article  PubMed  Google Scholar 

  30. Harriott AM, Barrett KM (2015) Dissecting the Association Between Migraine and Stroke. Curr Neurol Neurosci Rep 15(3):1–14

    Article  CAS  Google Scholar 

  31. 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

    Article  Google Scholar 

  32. 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

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cheng Peng.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-016-2746-z

Keywords

Navigation