TY - JOUR
T1 - Migraine Age of Onset and Association With Ischemic Stroke in Late Life
T2 - 20 Years Follow-Up in ARIC
AU - Androulakis, X. Michelle
AU - Sen, Souvik
AU - Kodumuri, Nishanth
AU - Zhang, Tianming
AU - Grego, John
AU - Rosamond, Wayne
AU - Gottesman, Rebecca F.
AU - Shahar, Eyal
AU - Peterlin, B. Lee
N1 - Funding Information:
Funding: The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract numbers (HHSN268201700001I, HHSN2682017000 03I, HHSN268201700005I, HHSN268201700004I, and HHSN-2682017000021).
Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract numbers (HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, and HHSN2682017000021).The authors thank the staff and the participants of the ARIC study for their important contributions. Statistical analysis was conducted by Dr. Tianming Zhang, Dr. John Grego, Dr. Nishanth Kodumuri, University of South Carolina.
Funding Information:
Conflict of Interest: X. Michelle Androulakis, Nishanth Kodumuri, Tianming Zhang, Souvik Sen, Wayne Rosamond, and Eyal Shahar report no conflicts of interest. B. Lee Peterlin reports funding by NIH/NINDS (grant # K23-NS078345); serves on the editorial boards for the journal Neurology and as an associate editor for the journal Headache. Rebecca Gottesman is an associate editor for the journal Neurology.
Publisher Copyright:
© 2019 American Headache Society
PY - 2019/4
Y1 - 2019/4
N2 - Background and Purpose: To evaluate the association between cumulative exposure to migraine and incidence of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study. Methods: In this ongoing, prospective longitudinal community-based cohort, participants were interviewed to ascertain migraine history at the third visit (1993–1995), followed for ischemic stroke incidence over 20 years. We performed a post hoc analysis to evaluate the association between the age of migraine onset and ischemic stroke. Results: We identified 447 migraineurs with aura (MA) and 1128 migraineurs without aura (MO) among 11,592 black and white participants. There was an association between the age of MA onset ≥50 years old (average duration = 4.75 years) and ischemic stroke when compared to no headache group (multivariable adjusted HR = 2.17, 95% CI [1.39–3.39], P <.001). MA onset <50 years old (average duration = 28.17 years) was not associated with stroke (multivariable adjusted HR = 1.31, 95% CI [0.86–2.02], P =.212). These results were consistent with our logistic regression model. MO was not associated with increased stroke regardless of the age of onset. The absolute risk for stroke in migraine with aura is 37/447 (8.27%) and migraine without aura is 48/1128 (4.25%). Conclusion: As compared to the no headache participants, increased stroke risk in late life was observed in participants with late onset of MA. In this cohort, longer cumulative exposure to migraine with visual aura, as would be expected with early onset of migraine, was not associated with increased risk of ischemic stroke in late life. This study underscores the importance of the age of onset of MA in assessing stroke risk in older migraineurs.
AB - Background and Purpose: To evaluate the association between cumulative exposure to migraine and incidence of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study. Methods: In this ongoing, prospective longitudinal community-based cohort, participants were interviewed to ascertain migraine history at the third visit (1993–1995), followed for ischemic stroke incidence over 20 years. We performed a post hoc analysis to evaluate the association between the age of migraine onset and ischemic stroke. Results: We identified 447 migraineurs with aura (MA) and 1128 migraineurs without aura (MO) among 11,592 black and white participants. There was an association between the age of MA onset ≥50 years old (average duration = 4.75 years) and ischemic stroke when compared to no headache group (multivariable adjusted HR = 2.17, 95% CI [1.39–3.39], P <.001). MA onset <50 years old (average duration = 28.17 years) was not associated with stroke (multivariable adjusted HR = 1.31, 95% CI [0.86–2.02], P =.212). These results were consistent with our logistic regression model. MO was not associated with increased stroke regardless of the age of onset. The absolute risk for stroke in migraine with aura is 37/447 (8.27%) and migraine without aura is 48/1128 (4.25%). Conclusion: As compared to the no headache participants, increased stroke risk in late life was observed in participants with late onset of MA. In this cohort, longer cumulative exposure to migraine with visual aura, as would be expected with early onset of migraine, was not associated with increased risk of ischemic stroke in late life. This study underscores the importance of the age of onset of MA in assessing stroke risk in older migraineurs.
KW - ischemic stroke
KW - migraine onset
KW - migraine with aura
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U2 - 10.1111/head.13468
DO - 10.1111/head.13468
M3 - Article
C2 - 30663778
AN - SCOPUS:85060483373
SN - 0017-8748
VL - 59
SP - 556
EP - 566
JO - Headache
JF - Headache
IS - 4
ER -