Onset of migraine with aura before age of 50 not linked to risk of ischemic stroke

Migraine with aura was associated with an increased risk of ischemic stroke in the Atherosclerosis Risk in Communities study, but a recent post-hoc analysis published in Headache reveals unexpected results suggesting that onset of such migraines before age 50 years is not associated with such risk. Later onset of migraine with aura was linked with a higher risk, however.

The analysis included 447 migraineurs with aura (MA) and 1,128 migraineurs without aura (MO) among 11,592 participants (elderly men and women with a history of migraine). Over 20 years, there was a twofold increased risk of ischemic stroke when the age of MA onset was 50 years or older when compared with no headache. MA onset before 50 years old was not associated with stroke. Also, MO was not associated with increased stroke risk regardless of age of onset.

In the elderly population in this study, the absolute risk for stroke in MA was 37/447 (8.27 percent) and in MO was 48/1,128 (4.25 percent).

"I think clinically this is very meaningful, as many individuals with a long history of migraine are concerned about their stroke risk, especially when they get older and when they have other cardiovascular disease risks," said lead author Dr. X. Michelle Androulakis, Chief of Neurology at WJB Dorn VA Medical Center, in South Carolina. "Cumulative effects of migraine alone--with onset of migraine before age of 50--did not increase stroke risk in late life in this study cohort. On the contrary, the recent onset of migraine at or after age 50 is associated with increased stroke risk in late life."