Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults

Valeria De Giuli, Mario Grassi, Corrado Lodigiani, Rosalba Patella, Marialuisa Zedde, Carlo Gandolfo, Andrea Zini, Maria Luisa DeLodovici, Maurizio Paciaroni, Massimo Del Sette, Cristiano Azzini, Antonella Toriello, Rossella Musolino, Rocco Salvatore Calabrò, Paolo Bovi, Maria Sessa, Alessandro Adami, Giorgio Silvestrelli, Anna Cavallini, Simona Marcheselli, Domenico Marco Bonifati, Nicoletta Checcarelli, Lucia Tancredi, Alberto Chiti, Enrico Maria Lotti, Elisabetta Del Zotto, Giampaolo Tomelleri, Alessandra Spalloni, Elisa Giorli, Paolo Costa, Loris Poli, Andrea Morotti, Filomena Caria, Alessia Lanari, Giacomo Giacalone, Paola Ferrazzi, Alessia Giossi, Valeria Piras, Davide Massucco, Cataldo D'Amore, Filomena Di Lisi, Ilaria Casetta, Laura Cucurachi, Masina Cotroneo, Alessandro De Vito, Elisa Coloberti, Maurizia Rasura, Anna Maria Simone, Massimo Gamba, Paolo Cerrato, Giuseppe Micieli, Giovanni Malferrari, Maurizio Melis, Licia Iacoviello, Alessandro Padovani, Alessandro Pezzini
JAMA Neurology 2017 May 1, 74 (5): 512-518

Importance: Although sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS).

Objective: To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.

Design, Setting, and Participants: A prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine.

Main Outcomes and Measures: Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS.

Results: Of the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P < .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95% CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95% CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95% CI, 1.22-2.71). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P > .99).

Conclusions and Relevance: In patients with IS aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with CEAD. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms.


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