New research has expanded on the relationship between migraine and stroke. In this post, we explore what researchers found in these studies and what it means for you.

A recent analysis published in the British Medical Journal showed a correlation between any migraine diagnosis (both with and without aura) and an increased risk for what’s called a perioperative ischemic stroke. This type of stroke is defined as an obstruction of blood flow to the brain during or within 30 days of surgery¹. The same study—which analyzed more than 124,000 surgical cases in Massachusetts from 2007 to 2014—also found that 30-day hospital readmission rates after surgery were higher for those who had migraine. In both of these instances, patients diagnosed with migraine with aura had an even greater risk than those without aura. These observations also remained consistent when taking into account other risk factors related to both the surgical procedure and other diseases or conditions. This supports previous research showing migraine with aura increases stroke risk for many different types.

It is important to note that the chances of experiencing this type of stroke is still relatively small. Researchers predicted an absolute risk of approximately 4 perioperative ischemic strokes per 1000 patients with migraine (compared to 2 instances per 1000 patients without migraine). And just because there is a connection between these two conditions in the research does not necessarily mean that having migraine can cause a stroke. However, it is important to be aware of these potential risks and to consult with the appropriate medical professionals prior to undergoing surgery.

A second study published last December identified a connection between specific migraine subtypes, use of combined hormonal contraceptives (CHC) and ischemic stroke. The most common type of stroke, an ischemic stroke occurs when a blood clot forms and prevents blood from reaching the brain, according to the National Stroke Association. In this recent examination—which consisted of more than 25,000 ischemic strokes among women from a national health database between 2006 and 2012—it was revealed that patients who had migraine with aura and used CHCs were six times more likely to experience ischemic stroke; conversely, there was no significant risk increase for those with migraine without aura who also use CHCs.

Prior research has suggested that “migraine with aura [is] associated with an increased risk of ischemic stroke, and that this risk may be further elevated in the setting of combined estrogen-progesterone contraceptive use,” and this new study would seem to directly support those findings. Again, these are small percentages, and further analysis may be warranted in determining how specific migraine subtypes may adversely affect other health outcomes.

Organizations such as the World Health Organization have recommended that those with migraine aura avoid combination contraceptives. But others² have suggested that it should be addressed on a case-by-case basis and that other risk factors should be taken into consideration. For now, the best course of action is to work with your doctor or headache specialist to determine the appropriate course of action. And in the meantime, we’ll continue to follow the research.

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References:

Champaloux SW, Tepper NK, Monsour M, et al. Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Am J Obstet Gynecol 2016.

Timm Fanny P, Houle Timothy T, Grabitz Stephanie D, Lihn Anne-Louise, Stokholm Janne B, Eikermann-Haerter Katharina et al. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ2017;356:i6635.

¹ George A. Mashour, MD, PhD, Laurel E. Moore, MD, Abhijit V. Lele, MD,w Steven A. Robicsek, MD, PhD,z and Adrian W. Gelb, MBChB. Perioperative Care of Patients at High Risk for Stroke during or after Non-Cardiac, Non-Neurologic Surgery: Consensus Statement from the Society for Neuroscience in Anesthesiology and Critical Care. J Neurosurg Anesthesiol 2014;00:000–000.

² Andrea G Edlow, MD, MSc and Deborah Bartz, MD, MPH. Hormonal Contraceptive Options for Women With Headache: A Review of the Evidence. Rev Obstet Gynecol. 2010 Spring; 3(2): 55–65.