Those of you who have followed my work over the last few years have seen me warn that Migraine disease, especially with prolonged Migraine attacks, increases our risk of stroke. MAGNUM, the National Migraine Association, has taken this position for over a decade. Our position was based on studies that were legitimate, but not very well known, as well as unfortunate anecdotal evidence from Migraineurs who had experienced Migrainous strokes and turned to us for education and support.
Now, an interesting paper has been published that pulls together data from 14 studies, correlating and analyzing the data to offer a more conclusive overall picture. "Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies" uses data from studies conducted between 1966 and June of 2004, that examined the association between migraine and risk of ischemic stroke.
The results of their analysis:
- The averaged risk of stroke for all Migraineurs was 2.16 times that of people without Migraine.
- Migraineurs who experience Migraine with and without aura had 2.27 and 1.83 times the risk factor of that of non-Migraineurs.
- Adding oral contraceptives resulted in increasing the risk of stroke by approximately eight times.
Etminan et al say the results "strongly suggest that Migraine may be an independent risk factor for stroke."1 Their review and interpretation of the studies gives an interpretation to the data that warrants a need for future study into the link between Migraine and stroke, the mechanism of Migraine-related stroke, and the increased risk presented by oral contraceptives.
Dr. Anne MacGregor, director of clinical research at the City of London Migraine Clinic and acting general secretary of the International Headache Society (IHS), commented, "There is no doubt that there is a relationship between migraine and stroke, and that the risk is greater with aura migraines and women on the pill. That is indisputable...."2
For added perspective, I went to Dr. Fred Sheftell, founder and director of the New England Center for Headache in Stamford, Connecticut, and a well known researcher and author in the field. He provided statistics for those without Migraine disease and compared them to those for Migraineurs:
- "The average stroke prevalence in women in the general population is 9 per 100,000, which represents absolute risk.
- If patients with migraine have an average of 2.16 times greater risk that's about 20 per 100,000, still avery low absolute risk.
- On oral contraceptives, theabsolute risk is about 75 per 100,000.
What this study does not indicate is that Migraineurs should panic. As with any disease, we need to know any risks Migraine presents so we are prepared and can do our part to take care of ourselves to avoid complications.
When to seek immediate care:
- If you have the worst headache or Migraine of your life. Extreme head pain can be a symptom of a stroke. Even though she was suffering from an aneurysm, Sharon Stone said it best, "If you have the worst headache you've ever had, go to the hospital because by the time you get to the hospital, you're as far gone as you wanna be."
- If you experience numbness or paralysis that you have not experienced with a Migraine before.
- If you lose consciousness during a Migraine, it hasn't happened to you during previous Migraines, and you haven't discussed it with your doctor.
- If you have a severe, unremitting Migraine for more than 72 hours, it is Status Migrainous, and you should call your doctor or go to the ER.
- Obviously, it's impossible to predict all circumstances under which we might need to call our doctor or go to the emergency room. If your Migraine seems out of control and frightening, it's better to get it checked out and be safe
Talk to your doctor about risk factors for stroke. You can also find helpful information about stroke prevention at the the American Stroke Association. Education is a vital part of our medical care. Now that we know about the increased stroke risk associated with Migraine, rather than letting it make us fearful, let's use it as motivation. Are our lifestyles as healthy as they should be? How can we modify them to reduce risk factors? We may have Migraine disease, but let's work to control it rather than letting it control us.
>> To read a more detailed version of this article, click HERE.<<
1 Etminan, Mahar; Takkouche, Bahi; Isorna, Francisco Caamaño; Samii, Ali. "Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies." BMJ, doi:10.1136/bmj.38302.504063.8F. December 13, 2004.
"Migraines 'double' risk of stroke." BBC News UK Edition. December 13, 2004.