Linstra Katie M, van Os Hendrikus J A, Ruigrok Ynte M, Nederkoorn Paul J, van Dijk Ewoud J, Kappelle L Jaap, Koudstaal Peter J, Visser Marieke C, Ferrari Michel D, MaassenVanDenBrink Antoinette, Terwindt Gisela M, Wermer Marieke J H
Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.
Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands.
Front Neurosci. 2021 Nov 3;15:740639. doi: 10.3389/fnins.2021.740639. eCollection 2021.
An increased risk of stroke in patients with migraine has been primarily found for women. The sex-dependent mechanisms underlying the migraine-stroke association, however, remain unknown. This study aims to explore these sex differences to improve our understanding of pathophysiological mechanisms behind the migraine-stroke association. We included 2,492 patients with ischemic stroke from the prospective multicenter Dutch Parelsnoer Institute Initiative study, 425 (17%) of whom had a history of migraine. Cardiovascular risk profile, stroke cause (TOAST classification), and outcome [modified Rankin scale (mRS) at 3 months] were compared with both sexes between patients with and without migraine. A history of migraine was not associated with sex differences in the prevalence of conventional cardiovascular risk factors. Women with migraine had an increased risk of stroke at young age (onset < 50 years) compared with women without migraine (RR: 1.7; 95% CI: 1.3-2.3). Men with migraine tended to have more often stroke in the TOAST category other determined etiology (RR: 1.7; 95% CI: 1.0-2.7) in comparison with men without migraine, whereas this increase was not found in women with migraine. Stroke outcome was similar for women with or without migraine (mRS ≥ 3 RR 1.1; 95% CI 0.7-1.5), whereas men seemed to have a higher risk of poor outcome compared with their counterparts without migraine (mRS ≥ 3 RR: 1.5; 95% CI: 1.0-2.1). Our results indicate possible sex differences in the pathophysiology underlying the migraine-stroke association, which are unrelated to conventional cardiovascular risk factors. Further research in larger cohorts is needed to validate these findings.
偏头痛患者中风风险增加主要见于女性。然而，偏头痛与中风关联背后的性别依赖性机制仍不清楚。本研究旨在探讨这些性别差异，以增进我们对偏头痛与中风关联背后病理生理机制的理解。我们纳入了前瞻性多中心荷兰珍珠研究所倡议研究中的2492例缺血性中风患者，其中425例（17%）有偏头痛病史。比较了有偏头痛和无偏头痛患者的心血管风险概况、中风病因（TOAST分类）及结局[3个月时的改良Rankin量表（mRS）]。偏头痛病史与传统心血管危险因素患病率的性别差异无关。与无偏头痛的女性相比，有偏头痛的女性在年轻时（发病年龄<50岁）中风风险增加（RR：1.7；95%CI：1.3 - 2.3）。与无偏头痛的男性相比，有偏头痛的男性在TOAST分类中其他确定病因的中风发生率更高（RR：1.7；95%CI：1.0 - 2.7），而有偏头痛的女性未发现这种增加。有或无偏头痛的女性中风结局相似（mRS≥3，RR 1.1；95%CI 0.7 - 1.5），而与无偏头痛的男性相比，有偏头痛的男性预后不良风险似乎更高（mRS≥3，RR：1.5；95%CI：1.0 - 2.1）。我们的结果表明偏头痛与中风关联背后的病理生理可能存在性别差异，且与传统心血管危险因素无关。需要在更大队列中进行进一步研究以验证这些发现。
