Stroke

Stroke and Women

Women under the age of 45 who have migraine without aura may be at a slightly increased risk for stroke; women who have migraine with aura have more than twice the risk of heart attack or stroke than do women without aura or without migraine. This risk is further magnified if you smoke, have high blood pressure, or if you take oral contraceptives.

The relationship between migraine with aura and ischemic stroke before age 45 is well established, and there is also a relationship with TIA (transient ischemic attack) and subclinical lesions in the brain.  The authors of the GEM study (Genetic Epidemiology of Migraine Study) noted: “There has been substantial literature confirming an association between migraine with aura and ischemic stroke before the age of 45. The question of whether there is a similar association with CHD before the age of 45 has not yet been definitively answered."

It has been speculated that cortical spreading depression (CSD), which is presumed to be the basis of aura, could also predispose the brain to lesions, and possibly even stroke. Some researchers in the field think it possible that repeated episodes of CSD resulting in aura could be responsible for an increased risk of stroke.

The Reykjavik Study found that stroke occurrence was increased in men and women with migraine with aura, but that death due to stroke was only increased for men with migraine.

Meta-analyses of of studies of stroke in women with aura have determined that migraine confers a higher overall risk of both ischemic and hemorrhagic stroke. Migraine with aura in women confers an overall stroke risk of 4.3/1000, higher than either diabetes or obesity, and contributes as much risk as smoking or hypertension.

The CAMERA II study has shown that infarct size in stroke is 3.24 times larger in women with migraine with aura.

This underscores the necessity for women who have migraine with aura to control stroke risk factors as much as possible.

References:

1. Scher AI, Terwindt GM, Picavet HSJ, et al. Cardiovascular risk factors and migraine: the GEM population-based study. Neurology. 2005;64(4):614-620.

2. Schurks M, Rist PM, Bigal ME, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009;339(oct27 1):b3914

3. Gudmundsson LS, Scher AI, Aspelund T, et al. Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study. BMJ. 2010;341(aug24 1):c3966

4. Bigal ME, Kurth T, Hu H, Santanello N, Lipton RB. Migraine and cardiovascular disease. Neurology. 2009;72(21):1864 -1871.

5. Bigal ME, Kurth T, Santanello N, et al. Migraine and cardiovascular disease. Neurology. 2010;74(8):628 -635.

6. Eikermann-Haerter K, Lee JH, Yuzawa I, et al. Migraine Mutations Increase Stroke Vulnerability by Facilitating Ischemic Depolarizations. Circulation. 2012;125(2):335–345.

7. Palm-Meinders IH, Koppen H, Terwindt GM, et al. Structural Brain Changes in Migraine. JAMA. 2012;308(18):1889–1897.

 

 

by Christina Peterson, M.D.

updated 7-1-13