Androulakis X Michelle, Kodumuri Nishanth, Giamberardino Lauren D, Rosamond Wayne D, Gottesman Rebecca F, Yim Eunsil, Sen Souvik
From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
Neurology. 2016 Dec 13;87(24):2527-2532. doi: 10.1212/WNL.0000000000003428. Epub 2016 Nov 9.
To investigate the association among migraine, ischemic stroke, and stroke subtypes in the Atherosclerosis Risk in Communities (ARIC) study.
In this ongoing, prospective, longitudinal community-based cohort study, participants were given an interview ascertaining migraine history in 1993-1995, and were followed for all vascular events, including stroke. All stroke events over the subsequent 20 years were adjudicated and classified into stroke subtypes by standard definitions. Cox proportional hazards models adjusted for stroke risk factors were used to study the relationship between migraine and ischemic stroke, overall, as well as stroke subtypes (cardioembolic, lacunar, or thrombotic).
We identified 1,622 migraineurs among 12,758 participants. Mean age of the study population at the 3rd clinical visit was 59 years. When compared to nonheadache participants, there was a significant association between migraine with visual aura and ischemic stroke (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.2-2.6, p = 0.008). Migraine without visual aura was not significantly associated with ischemic stroke (HR 1.2, CI 1.0-1.8, p = 0.28) when compared to nonheadache participants. Among the 3 subtypes of ischemic stroke evaluated, migraine with visual aura was significantly associated only with cardioembolic stroke (HR 3.7, 95% CI 1.6-8.7, p = 0.003).
In participants with migraine with visual aura in late middle age, increased risk of cardioembolic stroke was observed. Migraine with visual aura was linked to increased stroke risk, while migraine without visual aura was not, over the period of 20 years. These results are specific to older migraineurs.
在社区动脉粥样硬化风险（ARIC）研究中，调查偏头痛、缺血性卒中及卒中亚型之间的关联。
在这项正在进行的、前瞻性、基于社区的纵向队列研究中，于1993 - 1995年对参与者进行访谈以确定偏头痛病史，并对包括卒中在内的所有血管事件进行随访。对随后20年中的所有卒中事件进行判定，并根据标准定义将其分为卒中亚型。使用针对卒中危险因素进行调整的Cox比例风险模型，研究偏头痛与缺血性卒中总体以及卒中亚型（心源性栓塞性、腔隙性或血栓性）之间的关系。
在12758名参与者中，我们识别出1622名偏头痛患者。第三次临床访视时研究人群的平均年龄为59岁。与无头痛的参与者相比，伴有视觉先兆的偏头痛与缺血性卒中之间存在显著关联（风险比[HR] 1.7，95%置信区间[CI] 1.2 - 2.6，p = 0.008）。与无头痛的参与者相比，无视觉先兆的偏头痛与缺血性卒中无显著关联（HR 1.2，CI 1.0 - 1.8，p = 0.28）。在评估的缺血性卒中的3种亚型中，伴有视觉先兆的偏头痛仅与心源性栓塞性卒中显著相关（HR 3.7，95% CI 1.6 - 8.7，p = 0.003）。
在中年后期伴有视觉先兆的偏头痛参与者中，观察到心源性栓塞性卒中风险增加。在20年期间，伴有视觉先兆的偏头痛与卒中风险增加相关，而无视觉先兆的偏头痛则不然。这些结果特定于老年偏头痛患者。
