Risk of ischaemic stroke in people with migraine: systematic review an
http://www.100md.com
《英国医生杂志》
1 Divisions of Epidemiology, Royal Victoria and Vancouver Hospitals, Canada, 2 Department of Preventive Medicine, University of Santiago de Compostela, Spain, 3 Department of Neurology, University of Washington, Seattle, WA 98195, USA
Correspondence to: M Etminan, Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, QC, Canada H3A 1A1 Mahyar.etminan@mail.mcgill.ca
Abstract
Migraine is the most common type of headache in young adults, with an estimated prevalence of 4% before puberty and as high as 25% in women by their mid to late 30s.1 Some observational studies have shown an increase in the risk of stroke among people with a history of migraine,2 but others have failed to find this association.3 The mechanism of this potential association is believed to be in part through platelet hyperaggregability and the reduction in cerebral blood flow that usually occurs in migraine with aura.4 A potential association between the risk of stroke and migraine is an important public health concern, especially in young women who use oral contraceptives, which by itself may be an independent risk factor for stroke.5
We sought to explore the association between migraine and ischaemic stroke by conducting a meta-analysis. Specifically, we set out to quantify the risk of ischaemic stroke among people with migraine (with and without aura), as well as to quantify this risk among different age groups and users of oral contraceptives.
Methods
Our search resulted in 11 case-control studies,2-3 11-19 three cohort studies,20-22 and one cross sectional study23 (table 1). We excluded the cross sectional study from the analysis, as the timing of diagnosis of migraine with respect to development of ischaemic stroke was difficult to infer in this study. In total, we included 14 studies in the meta-analysis.2-3 11-22 Six studies provided data on the risk of ischaemic stroke and migraine with and without aura.2 3 12-14 17 The age of the participants in the included studies ranged from 15 to 84 years. The incidence of stroke among people with migraine in the three cohort studies ranged from 3.56 to 350 cases per 100 000 person years.20-22
Table 1 Relative risks of ischaemic stroke according to type of migraine
The pooled relative risk for ischaemic stroke among patients with any type of migraine headache was 2.16 (95% confidence interval 1.89 to 2.48) (table 2, fig 1). The relative risks for people with migraine with and without aura were 2.27 (1.61 to 3.19) and 1.83 (1.06 to 3.15). This risk did not differ when we stratified our analysis by age (table 2). Users of oral contraceptives had an approximately eightfold increase in the risk of stroke compared with those not using these agents.
Table 2 Pooled relative risks of ischaemic stroke stratified by migraine type, oral contraceptive use, and age
Fig 1 Forest plot of the studies of migraine and ischaemic stroke
We did not find evidence of publication bias either graphically from the funnel plot (fig 2) or quantitatively (P = 0.685 for Egger's test of asymmetry). The pooled relative risk for the sensitivity analysis still showed a significant increase in the risk of stroke (relative risk 1.43, 1.21 to 1.68).
Fig 2 Funnel plot of the studies of migraine and ischaemic stroke
Discussion
Silberstein SD. Migraine. Lancet 2004;363: 381-91.
Tzourio C, Tehindrazanarivelo A, Iglesias S, Alperovitch A, Chedru F, d'Anglejan-Chatillon J, et al. Case-control study of migraine and risk of ischaemic stroke in young women. BMJ 1995;310: 830-3.
Carolei A, Marini C, De Matteis G. History of migraine and risk of cerebral ischaemia in young adults. Lancet 1996;347: 1503-6.
Woods RP, Iacoboni M, Mazziotta JC. Brief report: bilateral spreading cerebral hypoperfusion during spontaneous migraine headache. N Engl J Med 1994;331: 1689-92.
Lidegaard O, Kreiner S. Contraceptives and cerebral thrombosis: a five-year national case-control study. Contraception 2002;65: 197-205.
Bhutta A, Cleves M, Casey P, Cradock M, Anand KJS. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 2002;288: 728-37.
Takkouche B, Cadarso-Suarez C, Spiegelman D. Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis. Am J Epidemiol 1999;150: 206-15.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315: 629-34.
Hernan MA, Takkouche B, Caamano-Isorna F, Gestal-Otero JJ. A meta-analysis of coffee drinking, cigarette smoking, and the risk of Parkinson's disease. Ann Neurol 2002;52: 276-84.
Costa-Bouzas J, Takkouche B, Cadarso-Suarez C, Spiegelman D. HEpiMA: software for the identification of heterogeneity in meta-analysis. Comput Methods Programs Biomed 2001;64: 101-7.
Collaborative Group for the Study of Stroke in Young Women. Oral contraceptives and stroke in young women. JAMA 1975;231: 718-22.
Henrich JB, Horwitz RI. A controlled study of ischemic stroke risk in migraine patients. J Clin Epidemiol 1989;42: 773-80.
Marini C, Carolei A, Roberts RS, Prencipe M, Gandolfo C, Inzitari D, et al. Focal cerebral ischemia in young adults: a collaborative case-control study. Neuroepidemiology 1993;12: 70-81.
Tzourio C, Iglesias S, Hubert JB, Visy JM, Alperovitch A, Tehindrazanarivelo A, et al. Migraine and risk of ischemic stroke: a case-control study. BMJ 1993;307: 289-92.
Lidegaard O. Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease. Br J Obstet Gynaecol 1995;102: 153-9.
Haapaniemi H, Hillbom M, Juvela S. Life-style associated risk factors for acute brain infarction among persons of working age. Stroke 1997;28: 26-30.
Chang CL, Donaghy M, Poulter N. Migraine and stroke in young women: case-control study. BMJ 1999;318: 13-8.
Donaghy M, Chang CL, Poulter N. Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age. J Neurol Neurosurg Psychiatry 2002;73: 747-50.
Schwaag S, Nabavi DG, Frese A, Husstedt IW, Evers S. The association between migraine and juvenile stroke: a case-control study. Headache 2003;43: 90-5.
Buring JE, Hebert P, Romero J, Kittross A, Cook N, Manson J, et al. Migraine and subsequent risk of stroke in the physicians' health study. Arch Neurol 1995;52: 129-34.
Merikangas KR, Fenton B, Cheng SH, Stolar MJ, Rish N. Association between migraine and stroke in a large-scale epidemiological study of the United States. Arch Neurol 1997;54: 362-8.
Nightingale AL, Farmer RD. Ischemic stroke in young women: a nested case-control study using the UK general practice research database. Stroke 2004;35: 1574-8.
Kruit MC, Buchem MA, Hofman P, Bakkers JT, Terwindt GM, Ferrari MD, et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004;291: 427-34.
Schwartz SM, Petitti DB, Siscovick DS, Longstreth WT Jr, Sidney S, Raghunathan TE, et al. Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke 1998;29: 2277-84.
Friberg L, Olsen TS, Roland PE, Lassen NA. Focal ischemia caused by instability of cerebro-vascular tone during attacks of hemiplegic migraine: a regional cerebral blood flow study. Brain 1987;110: 917-34.
Petty GW, Orencia AJ, Khandheria BK, Whisnant JP. A population based study of stroke in the setting of mitral valve prolapse: risk factors and infarct sub-type classification. Mayo Clin Proc 1994;69: 632-4.
Ridker PM, Hennekens CH, Stampfer MJ, Manson, Vaughan DE. Prospective study of endogenous tissue plasminogen activator and risk of stroke. Lancet 1994;343: 940-3.
Tietjen GE, Day M, Norris L, Aurora S, Halvorsen A, Shultz LR, et al. Role of anticardiolipin antibodies in young persons with migraine and transient focal neurologic events: a prospective study. Neurology 1998;50: 1433-40.
((Mahyar Etminan, pharmacoepidemiologist1,)
Correspondence to: M Etminan, Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, QC, Canada H3A 1A1 Mahyar.etminan@mail.mcgill.ca
Abstract
Migraine is the most common type of headache in young adults, with an estimated prevalence of 4% before puberty and as high as 25% in women by their mid to late 30s.1 Some observational studies have shown an increase in the risk of stroke among people with a history of migraine,2 but others have failed to find this association.3 The mechanism of this potential association is believed to be in part through platelet hyperaggregability and the reduction in cerebral blood flow that usually occurs in migraine with aura.4 A potential association between the risk of stroke and migraine is an important public health concern, especially in young women who use oral contraceptives, which by itself may be an independent risk factor for stroke.5
We sought to explore the association between migraine and ischaemic stroke by conducting a meta-analysis. Specifically, we set out to quantify the risk of ischaemic stroke among people with migraine (with and without aura), as well as to quantify this risk among different age groups and users of oral contraceptives.
Methods
Our search resulted in 11 case-control studies,2-3 11-19 three cohort studies,20-22 and one cross sectional study23 (table 1). We excluded the cross sectional study from the analysis, as the timing of diagnosis of migraine with respect to development of ischaemic stroke was difficult to infer in this study. In total, we included 14 studies in the meta-analysis.2-3 11-22 Six studies provided data on the risk of ischaemic stroke and migraine with and without aura.2 3 12-14 17 The age of the participants in the included studies ranged from 15 to 84 years. The incidence of stroke among people with migraine in the three cohort studies ranged from 3.56 to 350 cases per 100 000 person years.20-22
Table 1 Relative risks of ischaemic stroke according to type of migraine
The pooled relative risk for ischaemic stroke among patients with any type of migraine headache was 2.16 (95% confidence interval 1.89 to 2.48) (table 2, fig 1). The relative risks for people with migraine with and without aura were 2.27 (1.61 to 3.19) and 1.83 (1.06 to 3.15). This risk did not differ when we stratified our analysis by age (table 2). Users of oral contraceptives had an approximately eightfold increase in the risk of stroke compared with those not using these agents.
Table 2 Pooled relative risks of ischaemic stroke stratified by migraine type, oral contraceptive use, and age
Fig 1 Forest plot of the studies of migraine and ischaemic stroke
We did not find evidence of publication bias either graphically from the funnel plot (fig 2) or quantitatively (P = 0.685 for Egger's test of asymmetry). The pooled relative risk for the sensitivity analysis still showed a significant increase in the risk of stroke (relative risk 1.43, 1.21 to 1.68).
Fig 2 Funnel plot of the studies of migraine and ischaemic stroke
Discussion
Silberstein SD. Migraine. Lancet 2004;363: 381-91.
Tzourio C, Tehindrazanarivelo A, Iglesias S, Alperovitch A, Chedru F, d'Anglejan-Chatillon J, et al. Case-control study of migraine and risk of ischaemic stroke in young women. BMJ 1995;310: 830-3.
Carolei A, Marini C, De Matteis G. History of migraine and risk of cerebral ischaemia in young adults. Lancet 1996;347: 1503-6.
Woods RP, Iacoboni M, Mazziotta JC. Brief report: bilateral spreading cerebral hypoperfusion during spontaneous migraine headache. N Engl J Med 1994;331: 1689-92.
Lidegaard O, Kreiner S. Contraceptives and cerebral thrombosis: a five-year national case-control study. Contraception 2002;65: 197-205.
Bhutta A, Cleves M, Casey P, Cradock M, Anand KJS. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 2002;288: 728-37.
Takkouche B, Cadarso-Suarez C, Spiegelman D. Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis. Am J Epidemiol 1999;150: 206-15.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315: 629-34.
Hernan MA, Takkouche B, Caamano-Isorna F, Gestal-Otero JJ. A meta-analysis of coffee drinking, cigarette smoking, and the risk of Parkinson's disease. Ann Neurol 2002;52: 276-84.
Costa-Bouzas J, Takkouche B, Cadarso-Suarez C, Spiegelman D. HEpiMA: software for the identification of heterogeneity in meta-analysis. Comput Methods Programs Biomed 2001;64: 101-7.
Collaborative Group for the Study of Stroke in Young Women. Oral contraceptives and stroke in young women. JAMA 1975;231: 718-22.
Henrich JB, Horwitz RI. A controlled study of ischemic stroke risk in migraine patients. J Clin Epidemiol 1989;42: 773-80.
Marini C, Carolei A, Roberts RS, Prencipe M, Gandolfo C, Inzitari D, et al. Focal cerebral ischemia in young adults: a collaborative case-control study. Neuroepidemiology 1993;12: 70-81.
Tzourio C, Iglesias S, Hubert JB, Visy JM, Alperovitch A, Tehindrazanarivelo A, et al. Migraine and risk of ischemic stroke: a case-control study. BMJ 1993;307: 289-92.
Lidegaard O. Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease. Br J Obstet Gynaecol 1995;102: 153-9.
Haapaniemi H, Hillbom M, Juvela S. Life-style associated risk factors for acute brain infarction among persons of working age. Stroke 1997;28: 26-30.
Chang CL, Donaghy M, Poulter N. Migraine and stroke in young women: case-control study. BMJ 1999;318: 13-8.
Donaghy M, Chang CL, Poulter N. Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age. J Neurol Neurosurg Psychiatry 2002;73: 747-50.
Schwaag S, Nabavi DG, Frese A, Husstedt IW, Evers S. The association between migraine and juvenile stroke: a case-control study. Headache 2003;43: 90-5.
Buring JE, Hebert P, Romero J, Kittross A, Cook N, Manson J, et al. Migraine and subsequent risk of stroke in the physicians' health study. Arch Neurol 1995;52: 129-34.
Merikangas KR, Fenton B, Cheng SH, Stolar MJ, Rish N. Association between migraine and stroke in a large-scale epidemiological study of the United States. Arch Neurol 1997;54: 362-8.
Nightingale AL, Farmer RD. Ischemic stroke in young women: a nested case-control study using the UK general practice research database. Stroke 2004;35: 1574-8.
Kruit MC, Buchem MA, Hofman P, Bakkers JT, Terwindt GM, Ferrari MD, et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004;291: 427-34.
Schwartz SM, Petitti DB, Siscovick DS, Longstreth WT Jr, Sidney S, Raghunathan TE, et al. Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke 1998;29: 2277-84.
Friberg L, Olsen TS, Roland PE, Lassen NA. Focal ischemia caused by instability of cerebro-vascular tone during attacks of hemiplegic migraine: a regional cerebral blood flow study. Brain 1987;110: 917-34.
Petty GW, Orencia AJ, Khandheria BK, Whisnant JP. A population based study of stroke in the setting of mitral valve prolapse: risk factors and infarct sub-type classification. Mayo Clin Proc 1994;69: 632-4.
Ridker PM, Hennekens CH, Stampfer MJ, Manson, Vaughan DE. Prospective study of endogenous tissue plasminogen activator and risk of stroke. Lancet 1994;343: 940-3.
Tietjen GE, Day M, Norris L, Aurora S, Halvorsen A, Shultz LR, et al. Role of anticardiolipin antibodies in young persons with migraine and transient focal neurologic events: a prospective study. Neurology 1998;50: 1433-40.
((Mahyar Etminan, pharmacoepidemiologist1,)