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BMJ. 2017 Jan 10;356:i6635. doi: 10.1136/bmj.i6635.

Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study.

Author information

1
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
2
Department of Anesthesiology, University of Copenhagen, Herlev Hospital, Copenhagen, Denmark.
3
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
4
Institute of Public Health, Charité - Universitätsmedizin Berlin, Germany.
5
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA meikermann@partners.org.

Abstract

OBJECTIVE:

 To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate.

DESIGN:

 Prospective hospital registry study.

SETTING:

 Massachusetts General Hospital and two satellite campuses between January 2007 and August 2014.

PARTICIPANTS:

 124 558 surgical patients (mean age 52.6 years; 54.5% women).

MAIN OUTCOME MEASURES:

 The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura. The secondary outcome was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location.

RESULTS:

 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.6%) perioperative ischemic strokes occurred within 30 days of surgery. Patients with migraine were at increased risk of perioperative ischemic stroke (adjusted odds ratio 1.75, 95% confidence interval 1.39 to 2.21) compared with patients without migraine. The risk was higher in patients with migraine with aura (adjusted odds ratio 2.61, 1.59 to 4.29) than in those with migraine without aura (1.62, 1.26 to 2.09). The predicted absolute risk is 2.4 (2.1 to 2.8) perioperative ischemic strokes for every 1000 surgical patients. This increases to 4.3 (3.2 to 5.3) for every 1000 patients with any migraine diagnosis, 3.9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41).

CONCLUSIONS:

 Surgical patients with a history of migraine are at increased risk of perioperative ischemic stroke and have an increased 30 day hospital readmission rate. Migraine should be considered in the risk assessment for perioperative ischemic stroke.

PMID:
28073753
PMCID:
PMC5225233
DOI:
10.1136/bmj.i6635
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: TTH has received a research grant from Merck Inc, has served as a statistical consultant for Depomed Inc, receives payment for statistical reviewing from Anesthesiology, Annals of Surgery, and Headache, and has received research grants from National Institutes of Health (NINDS, NIGMS); TK has received grants from the Else-Kröner-Fresenius-Stiftung/German Scholars Organization, the US National Institutes of Health, and the French National Research Agency, is a consultant for Amgen on a scientific project, for which the Charité - Universitätsmedizin Berlin receives research funds, has received honorariums for editorial services from The BMJ and Cephalalgia, and, as a board of trustees member of the International Headache Society, has received compensation for travel and accommodation expenses; ME has received funding for research projects from Merck, has an equity stake at Calabash Bioscience Inc, and received funding from a research grant from the Buzen Fund, established by Jeffrey Buzen and Judith Buzen of Boston, Massachusetts; no other relationships or activities that could appear to have influenced the submitted work.

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