Advertisement

Neurological Sciences

, Volume 38, Issue 1, pp 33–40 | Cite as

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

  • Xianming Hu
  • Yingchun Zhou
  • Hongyang Zhao
  • Cheng PengEmail author
Review Article

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.

Keywords

Migraine Stroke Meta-analysis Prospective cohort studies 

Notes

Compliance with ethical standards

Conflict of interest

We declare we have no conflict of interest. No funding is received for this systematic review.

References

  1. 1.
    Elkind MS, Sacco RL (1998) Stroke risk factors and stroke prevention. Semin Neurol 18(4):429–440. doi: 10.1055/s-2008-1040896 CrossRefPubMedGoogle Scholar
  2. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 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 CrossRefPubMedGoogle Scholar
  4. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 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):362–368CrossRefPubMedGoogle Scholar
  6. 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 CrossRefPubMedGoogle Scholar
  7. 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 CrossRefPubMedGoogle Scholar
  8. 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):129–134CrossRefPubMedGoogle Scholar
  9. 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):563–568CrossRefPubMedGoogle Scholar
  10. 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 CrossRefPubMedGoogle Scholar
  11. 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):715–721CrossRefPubMedPubMedCentralGoogle Scholar
  12. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 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):1252–1260CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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):2008–2012CrossRefPubMedGoogle Scholar
  15. 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) CrossRefPubMedGoogle Scholar
  16. 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. 17.
    Greenland S (1987) Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 9:1–30PubMedGoogle Scholar
  18. 18.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188CrossRefPubMedGoogle Scholar
  19. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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 CrossRefPubMedGoogle Scholar
  21. 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 CrossRefPubMedGoogle Scholar
  22. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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):1001–1011CrossRefPubMedGoogle Scholar
  24. 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):91–96CrossRefPubMedGoogle Scholar
  25. 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):557–561CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Elliott D (2008) Migraine and stroke: current perspectives. Neurol Res 30(8):801–812. doi: 10.1179/174313208X341049 CrossRefPubMedGoogle Scholar
  27. 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):984–987CrossRefPubMedPubMedCentralGoogle Scholar
  28. 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 CrossRefPubMedGoogle Scholar
  29. 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 CrossRefPubMedGoogle Scholar
  30. 30.
    Harriott AM, Barrett KM (2015) Dissecting the Association Between Migraine and Stroke. Curr Neurol Neurosci Rep 15(3):1–14CrossRefGoogle Scholar
  31. 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):1399–1421CrossRefGoogle Scholar
  32. 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 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Xianming Hu
    • 1
    • 2
  • Yingchun Zhou
    • 3
  • Hongyang Zhao
    • 3
  • Cheng Peng
    • 3
    Email author
  1. 1.Shanxi Children’s HospitalTaiyuanChina
  2. 2.School of Public HealthShanxi Medical UniversityTaiyuanChina
  3. 3.Affiliated Union Hospital of Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina

Personalised recommendations