van Os Hendrikus J A, Mulder Inge A, Broersen Alexander, Algra Ale, van der Schaaf Irene C, Kappelle L Jaap, Velthuis Birgitta K, Terwindt Gisela M, Schonewille Wouter J, Visser Marieke C, Ferrari Michel D, van Walderveen Marianne A A, Wermer Marieke J H
From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.).
Stroke. 2017 Jul;48(7):1973-1975. doi: 10.1161/STROKEAHA.116.016133. Epub 2017 May 19.
Migraine is a well-established risk factor for ischemic stroke, but migraine is also related to other vascular diseases. This study aims to investigate the association between migraine and cerebrovascular atherosclerosis in patients with acute ischemic stroke.
We retrieved data on patients with ischemic stroke from the DUST (Dutch Acute Stroke Study). Migraine history was assessed with a migraine screener and confirmed by telephone interview based on the ICHD criteria (International Classification of Headache Disorders). We assessed intra- and extracranial atherosclerotic changes and quantified intracranial internal carotid artery calcifications as measure of atherosclerotic burden on noncontrast computed tomography and computed tomographic angiography. We calculated risk ratios with adjustments for possible confounders with multivariable Poisson regression analyses.
We included 656 patients, aged 18 to 99 years, of whom 53 had a history of migraine (29 with aura). Patients with migraine did not have more frequent atherosclerotic changes in intracranial (51% versus 74%; adjusted risk ratio, 0.82; 95% confidence interval, 0.64-1.05) or extracranial vessels (62% versus 79%; adjusted risk ratio, 0.93; 95% confidence interval, 0.77-1.12) than patients without migraine and had comparable internal carotid artery calcification volumes (largest versus medium and smallest volume tertile, 23% versus 35%; adjusted risk ratio, 0.93; 95% confidence interval, 0.57-1.52).
Migraine is not associated with excess atherosclerosis in large vessels in patients with acute ischemic stroke. Our findings suggest that the biological mechanisms by which migraine results in ischemic stroke are not related to macrovascular cerebral atherosclerosis.
偏头痛是缺血性卒中公认的危险因素，但偏头痛也与其他血管疾病相关。本研究旨在探讨急性缺血性卒中患者偏头痛与脑血管动脉粥样硬化之间的关联。
我们从荷兰急性卒中研究（DUST）中检索了缺血性卒中患者的数据。使用偏头痛筛查工具评估偏头痛病史，并根据国际头痛疾病分类（ICHD）标准通过电话访谈进行确认。我们评估了颅内和颅外动脉粥样硬化变化，并在非增强计算机断层扫描和计算机断层血管造影上对颅内颈内动脉钙化进行量化，作为动脉粥样硬化负担的指标。我们通过多变量泊松回归分析对可能的混杂因素进行调整后计算风险比。
我们纳入了656例年龄在18至99岁之间的患者，其中53例有偏头痛病史（29例有先兆）。与无偏头痛的患者相比，有偏头痛的患者在颅内（51%对74%；调整后风险比为0.82；95%置信区间为0.64 - 1.05）或颅外血管（62%对79%；调整后风险比为0.93；95%置信区间为0.77 - 1.12）发生动脉粥样硬化变化的频率并不更高，并且颈内动脉钙化体积相当（最大体积三分位数与中等和最小体积三分位数相比，23%对35%；调整后风险比为0.93；95%置信区间为0.57 - 1.52）。
偏头痛与急性缺血性卒中患者大血管中过多的动脉粥样硬化无关。我们的研究结果表明，偏头痛导致缺血性卒中的生物学机制与大脑大血管动脉粥样硬化无关。
