Carolei A, Marini C, De Matteis G
Institute of Neurology, Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila-Collemaggio, Italy.
Lancet. 1996 Jun 1;347(9014):1503-6. doi: 10.1016/s0140-6736(96)90669-8.
A history of migraine has been proposed as a risk factor for cerebral ischaemia in women under 45.
To investigate the association between history of migraine and cerebral ischaemia, we performed a case-control study of 308 patients aged 15-44, with either transient ischaemic attack (TIA) or stroke, and of 591 age- and sex-matched controls prospectively recruited in seven university hospitals. Crude and adjusted odds ratios were calculated using logistic regression analysis.
A history of migraine was more frequent in patients than in controls (14.9% vs 9.1%; adjusted odds ratio 1.9, 95% confidence interval 1.1-3.1). In the prospectively designed subgroup analyses, a history of migraine reached the highest odds ratio (3.7, 95% CI 1.5-9) and was the only significant risk factor in women below age 35 (p=0.003); atherogenic risk factors were more relevant in men and in patients older than 35; previous migraine attacks with aura were more frequent in stroke patients (odds ratio 8.6, 95% CI 1-75).
Our findings indicated that the rare association between migraine and cerebral ischaemia is limited to women below age 35, and suggest a need for careful clinical evaluation of comorbidity in the presence of migraine with aura.
偏头痛病史被认为是45岁以下女性发生脑缺血的一个危险因素。
为了研究偏头痛病史与脑缺血之间的关联，我们进行了一项病例对照研究，研究对象为308例年龄在15 - 44岁之间、患有短暂性脑缺血发作（TIA）或中风的患者，以及591例在7所大学医院前瞻性招募的年龄和性别匹配的对照者。使用逻辑回归分析计算粗比值比和调整后的比值比。
偏头痛病史在患者中比在对照者中更常见（14.9%对9.1%；调整后的比值比为1.9，95%置信区间为1.1 - 3.1）。在前瞻性设计的亚组分析中，偏头痛病史的比值比最高（3.7，95%置信区间为1.5 - 9），并且是35岁以下女性中唯一显著的危险因素（p = 0.003）；动脉粥样硬化危险因素在男性和35岁以上患者中更为相关；有先兆的既往偏头痛发作在中风患者中更常见（比值比8.6，95%置信区间为1 - 75）。
我们的研究结果表明，偏头痛与脑缺血之间罕见的关联仅限于35岁以下女性，并提示在伴有先兆偏头痛的情况下需要对合并症进行仔细的临床评估。
