Department of Neurology, University of Toulouse, Toulouse, France.
ToNIC, Toulouse NeuroImaging Center, University of Toulouse, INSERM, France.
Cephalalgia. 2021 Mar;41(3):375-382. doi: 10.1177/0333102420970880. Epub 2020 Nov 17.
Migraine is associated with an increased risk of ischemic stroke. The associations are stronger in migraine with aura than in migraine without aura, in women than in men, and in younger subjects. However, the mechanisms by which migraine might increase the risk of ischemic stroke are debated.
We analysed the associations between migraine without aura and migraine with aura and the causes of ischemic stroke in patients aged 18-54 years treated consecutively in a university hospital stroke center.
A total of 339 patients (mean/SD age 43.8/8.8 years, 62.83% male) were included. Migraine with aura was diagnosed in 58 patients, and migraine without aura in 54 patients. Patients with migraine with aura were younger and had fewer traditional cardiovascular risk factors than patients with no migraine. Migraine with aura was strongly associated with atrial fibrillation (odds ratio, 5.08; 95% confidence interval, 1.24-21.92; = 0.011) and negatively associated with atherosclerosis (odds ratio, 0.29; 95% confidence interval, 0.05-0.97; = 0.033) and small vessel disease (odds ratio, 0.13; 95% confidence interval, 0.00-0.87; = 0.022). No other cause of stroke was significantly associated with migraine. The most common cause of stroke was atherosclerosis in no-migraine patients, dissection in migraine without aura patients and patent foramen ovale in migraine with aura patients. Atrial fibrillation was, together with dissection, the second leading cause of stroke in migraine with aura patients, accounting for 10.34% of cases in this subgroup.
We showed that atrial fibrillation was a common cause of ischemic stroke in young adults with migraine with aura.
偏头痛与缺血性中风的风险增加有关。偏头痛伴先兆比无先兆偏头痛、女性比男性、年轻患者的相关性更强。然而，偏头痛增加缺血性中风风险的机制仍存在争议。
我们分析了在大学医院卒中中心连续治疗的 18-54 岁患者中，无先兆偏头痛和有先兆偏头痛与缺血性中风病因之间的关系。
共纳入 339 例患者（平均/标准差年龄 43.8/8.8 岁，62.83%为男性）。诊断为有先兆偏头痛 58 例，无先兆偏头痛 54 例。有先兆偏头痛患者比无偏头痛患者年轻，且传统心血管危险因素较少。有先兆偏头痛与心房颤动强烈相关（比值比 5.08；95%置信区间 1.24-21.92；=0.011），与动脉粥样硬化（比值比 0.29；95%置信区间 0.05-0.97；=0.033）和小血管疾病（比值比 0.13；95%置信区间 0.00-0.87；=0.022）呈负相关。其他中风病因与偏头痛均无显著相关性。无偏头痛患者中风的最常见病因是动脉粥样硬化，无先兆偏头痛患者是夹层，有先兆偏头痛患者是卵圆孔未闭。在有先兆偏头痛患者中，心房颤动与夹层一起是中风的第二大病因，占该亚组病例的 10.34%。
我们表明，心房颤动是年轻偏头痛伴先兆患者缺血性中风的常见病因。
