Article: Migraine with Aura Doubles Stroke Risk

[Jae Onasi]

You'll need a Medscape account to see the whole article, but the results were quite interesting. http://cme.medscape.com/viewarticle/711940?src=mpnews&spon=16&uac=13144BX

As a note--I've been signed up on Medscape for about 10 years now, and I've never once received spam. They don't sell your email to third parties, and you can sign up for various newsletters from them depending on your particular interests. I'm signed up on the ophthalmology, general medicine, and women's medicine lists, for instance. I don't believe you have to be a medical professional to sign up.

The take home message: if you get migraines with aura, you need to minimize controllable risk factors for cardiovascular disease, such as high blood pressure, high cholesterol, and smoking. Smokers had a NINE times higher risk for stroke than non-smokers.

November 6, 2009 — Migraine with aura (but not migraine without aura) is associated with a 2-fold increased risk for ischemic stroke, according to a new meta-analysis reported in the October 28 Online First issue of the BMJ. The risk was highest among young women with migraine with aura who smoke and use estrogen-containing contraceptives.

Lead author Markus Schϋrks, MD, and colleagues at Brigham and Women's Hospital in Boston, Massachusetts, from migraine expert Dr. Tobias Kurth's group at INSERM in Paris, France, and at Merck Research Laboratories, Whitehouse Station, New Jersey, analyzed 25 case-control and cohort studies of association between any migraine type and cardiovascular disease. They found a significant association between any migraine and ischemic stroke risk, but this was because of a higher risk among people who had migraine with aura (relative risk [RR], 2.16). Risk was not elevated in migraine without aura.

The increase in stroke risk was also greater in women vs men (RR, 2.08 vs 1.37), in migraine patients younger than 45 years (RR, 2.65 vs > 45 years), in smokers (RR, 9.03 vs nonsmokers) and in women currently using oral contraceptives (RR, 7.02 vs nonusers).

Dr. Loder, who wrote an editorial to the article, wanted to put the article in perspective. The risk of stroke with migraine is low to begin with, and doubling that risk should not cause panic.

Nevertheless, this was an interesting article. Since many suffer from migraines, or know people who suffer from migraines, I thought it might be a good idea to bring it up here.

[Tommycat]

Pardon my ignorance, but could you define the difference between migraine with aura and without? Id that the one where you can't even look at light or the one where you get blurry vision...

[Jae Onasi]

With both types of migraines, you get the terrible headache. With the aura, however, you get warning symptoms that are usually visual but sometimes aural. My patients often describe these auras as flashing lights with jagged edges that expand in size, sometimes developing a blind spot in the center of the light. These usually last a few minutes, and then they get the bad headache shortly thereafter.

[vanir]

You realise when you say things like "my patients describe" it just makes me picture a busty blonde in knee high boots and a miniskirt.

Me I lose hearing, typically in the left ear. Then I know a battle of breathing exercises is going to be the order of the day. I see sparks sometimes but that's usually associated with dizziness, probably the strongest sensation I get is the feeling of a liquid of some sort moving around, well that is I'm trying to move it around with concentration, to get it the hell away from me. That's the weirdest feeling, as if there was just some unknown thought or manner of thinking and concentration that could push it all right off your body completely.
When you can't all you can do is have a nap clutching your skull. It feels like someone has drilled a hole in your skull and cold air can just painfully blow through accentuating the ache. Not very pleasant, best to be drunk. Meh lately I've had blood in my throat a lot and scary looking moles on my legs so I'm not exactly holding out a lot of hope anyway. Sorta tired out from hard battles already fought, ya know? Point being I wouldn't know if they were migraines or not, if so it's been a ten year migraine that only occaisionally moves to the background. I move around so much I really can't be bothered bringing GP's up to date, the last one overreacts first and thinks I've got a brain tumor (had a dilated pupil in one eye that day) then goes the other extreme and calls me a hyperchondriac in need of counselling, dude I just came in for a doctors certificate for work, mate, tell it to the hand.
Some doctors I like, really like, some I really want to punch in the face.