Hoffmann Michael
Department of Urology, University of South Florida, Tampa 33612, USA.
Headache. 2006 Feb;46(2):208-11. doi: 10.1111/j.1526-4610.2006.00333.x.
Cerebrovascular and cardiovascular complications in migraineurs may be part of the migraine process and also consequent to triptan treatment.
To determine the frequency, subtypes and associations of migraine-associated stroke and angina in young people (18-49 years).
Patients were derived from a tertiary referral migraine and stroke registry. Migraine-associated stroke was classified according to the four groups described by Welch and by the TOAST etiological stroke classification. A clinical description of angina during a migraine attack was required for the diagnosis of cardiac migraine without concomitant triptan or other vasoactive medications.
Of the young patients with stroke (349/1316; 26.5%), there were 30 (30/349; 8.6%) who had migraine at the time of stroke when categorized by the Welch classification type II to IV (type II n = 5, type III n = 2, type IV n = 3). Comparison of type I (n = 20) versus types II-IV (n = 10) showed significant difference (P = .03). Topographically the lesions were distributed into the partial anterior circulation (n = 8) and posterior circulation (n = 2) (P = .04). Comparison of anterior and posterior circulation territories of infarction indicated significant difference (n = 26/30 and 4/30; P = .01). The stroke etiological subtypes included cardiogenic (n = 5), atherogenic (n = 15), other (n = 5), and unknown (n = 5), with none diagnosed with small-vessel cerebrovascular disease. Traditional stroke mechanistic entities (cardiac and atherogenic) differed significantly in comparison to the other and unknown categories P = .05. Cardiovascular patients with angina during a migraine attack (n = 9/1040; 0.9%), included IHS subtypes; migraine without aura (n = 4), migraine with aura (n = 4), and complicated migraine (n = 1). One patient required cardiac catheterization on account of significant ECG changes, with documented, reversible vasospasm.
(i) Migraine-induced stroke remains controversial, with only two probable cases of type Welch III A+B in a large registry. (ii) Cardiac migraine may be a distinct entity requiring careful differentiation from triptan-induced chest pain.
偏头痛患者的脑血管和心血管并发症可能是偏头痛发作过程的一部分，也可能是曲坦类药物治疗的结果。
确定年轻人（18 - 49岁）中偏头痛相关性卒中及心绞痛的发生率、亚型及相关性。
患者来源于三级转诊偏头痛和卒中登记处。偏头痛相关性卒中根据韦尔奇描述的四组以及TOAST病因学卒中分类进行分类。诊断无曲坦类药物或其他血管活性药物伴随的心脏性偏头痛需要对偏头痛发作期间的心绞痛进行临床描述。
在年轻卒中患者中（349/1316；26.5%），根据韦尔奇分类II至IV型（II型n = 5，III型n = 2，IV型n = 3），有30例（30/349；8.6%）在卒中时患有偏头痛。I型（n = 20）与II - IV型（n = 10）比较显示有显著差异（P = 0.03）。从病变部位来看，病变分布于部分前循环（n = 8）和后循环（n = 2）（P = 0.04）。梗死的前循环和后循环区域比较显示有显著差异（n = 26/30和4/30；P = 0.01）。卒中病因亚型包括心源性（n = 5）、动脉粥样硬化性（n = 15）、其他（n = 5）和不明（n = 5），无小血管脑血管病诊断。与其他和不明类别相比，传统卒中机制实体（心源性和动脉粥样硬化性）有显著差异（P = 0.05）。偏头痛发作时有心绞痛的心血管患者（n = 9/1040；0.9%），包括国际头痛学会（IHS）亚型；无先兆偏头痛（n = 4）、有先兆偏头痛（n = 4）和复杂性偏头痛（n = 1）。1例患者因显著的心电图改变需要进行心导管检查，记录显示为可逆性血管痉挛。
（i）偏头痛诱发的卒中仍存在争议，在一个大型登记处中仅发现两例可能的韦尔奇III A + B型病例。（ii）心脏性偏头痛可能是一个独特的实体，需要与曲坦类药物诱发的胸痛仔细鉴别。
