Early Onset of Migraine May Predispose Patients to Increased Risk of Stroke

A recent study found that younger patients with migraine had greater cerebrovascular reactivity (CVR) impairment in the posterior cerebral artery (PCA), which could lead to an increased risk of stroke.

Researchers recruited 248 patients with migraine into the cross-sectional study with an additional 105 patients as controls. Patients in the migraine arm were aged 21 to 60 years with a diagnosis of migraine with or without aura, with an absence of diagnosed vascular risk factors, and were not currently using any regular medications.

In order to measure CVR, 2 neurophysiologists used transcranial Doppler. Patients were considered interictal if they did not experience migraine headaches in the previous 48 hours, and the examination also included the bilateral middle cerebral arteries, bilateral PCAs, and basilar artery.

Researchers identified an association between age and CVR in the PCA in patients with migraine, although there was no correlation between CVR in the bilateral middle cerebral artery and basilar artery with age. Conversely, researchers did not identify any associations between age and CVR in any tested vessel.

In addition, the study authors noted that the age of onset fully mediated the effect of age on PCA CVR, while longer disease duration negatively modified the effect of age of onset.

“In migraineurs, younger age was associated with CVR reduction in the PCA. Younger age of onset may be a hidden risk factor mediating the paradoxical association between age and CVR. The association might explain an increased risk of stroke in younger migraineurs,” wrote the authors.

Reference

Lee M, Cho S, Woo S, Chung C. Paradoxical association between age and cerebrovascular reactivity in migraine: a cross sectional study [published online March 15, 2019]. J Neurol Sci. doi: 10.1016/j.jns.2019.01.039.