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Am J Med. 2010 Jul;123(7):612-24. doi: 10.1016/j.amjmed.2009.12.021. Epub 2010 May 20.

Migraine headache and ischemic stroke risk: an updated meta-analysis.

Author information

1
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md, USA.

Abstract

BACKGROUND:

Observational studies, including recent large cohort studies that were unavailable for prior meta-analysis, have suggested an association between migraine headache and ischemic stroke. We performed an updated meta-analysis to quantitatively summarize the strength of association between migraine and ischemic stroke risk.

METHODS:

We systematically searched electronic databases, including MEDLINE and EMBASE, through February 2009 for studies of human subjects in the English language. Study selection using a priori selection criteria, data extraction, and assessment of study quality were conducted independently by reviewer pairs using standardized forms.

RESULTS:

Twenty-one (60%) of 35 studies met the selection criteria, for a total of 622,381 participants (13 case-control, 8 cohort studies) included in the meta-analysis. The pooled adjusted odds ratio of ischemic stroke comparing migraineurs with nonmigraineurs using a random effects model was 2.30 (95% confidence interval [CI], 1.91-2.76). The pooled adjusted effect estimates for studies that reported relative risks and hazard ratios, respectively, were 2.41 (95% CI, 1.81-3.20) and 1.52 (95% CI, 0.99-2.35). The overall pooled effect estimate was 2.04 (95% CI, 1.72-2.43). Results were robust to sensitivity analyses excluding lower quality studies.

CONCLUSIONS:

Migraine is associated with increased ischemic stroke risk. These findings underscore the importance of identifying high-risk migraineurs with other modifiable stroke risk factors. Future studies of the effect of migraine treatment and modifiable risk factor reduction on stroke risk in migraineurs are warranted.

PMID:
20493462
PMCID:
PMC2900472
DOI:
10.1016/j.amjmed.2009.12.021
[Indexed for MEDLINE]
Free PMC Article

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