Abstract TP176: Arrhythmia And Stroke Risk Among Migraineurs With Aura As Predicted By CHA 2 Ds 2 -VASc Scoring Tool

Abstract

Introduction: Migraine with aura (MWA) is associated with increased risk of atrial fibrillation (AF) and stroke. A recent study found that among young adults with MWA, AF was the second most common cause of ischemic stroke behind high-risk patent foramen ovale. The CHA 2 DS 2 -VASc score predicts 1 year risk of thromboembolic events, and may further characterize stroke risk in this population. Objectives: We hypothesize that arrhythmias are more common in patients with MWA than migraine without aura (MWoA); and that among migraine patients with arrhythmia, MWA leads to higher ischemic stroke risk, as predicted by CHA 2 DS 2 -VASc. Methods: The American Registry for Migraine Research (ARMR) database consists of patient questionnaires and headache diagnoses from 9 headache centers. Data on history of arrhythmia can be used as a marker for AF and other arrhythmias with stroke risk. Patients in ARMR ages 18-86 with ICHD-3 diagnosis of migraine were divided into MWA or MWoA based on survey responses, and evaluated for history of arrhythmia. Predicted stroke risk in migraineurs with arrhythmia was then characterized by CHA 2 DS 2 -VASc score calculation. Results: 2406 patients were included in the analysis (21.8% MWA, 78.1% MWoA). Patient groups had comparable age and gender composition. Arrhythmias were more common in MWA patients (N=30, 5.7%) than MWoA (N=11, 0.58%) after adjusting for age, gender, substance abuse and cardiac risk factors (p<0.05). Among patients with arrhythmia, there was no significant difference between median CHA 2 DS 2 -VASc score in MWA (1, IQR1-2) and MWoA (2, IQR 1-3) groups (p=0.32), nor among individual CHA 2 DS 2 -VASc scores (p=0.449). This persisted when score was dichotomized with a cutoff of 2. Conclusions: Arrhythmia is more prevalent in patients with MWA than MWoA. However, higher risk of stroke in arrhythmic patients with aura is not predicted by CHA 2 DS 2 -VASc. This suggests that increased stroke risk in these patients may be independent of other stroke risk factors, and perhaps linked to the arrhythmias themselves. Our findings support the need for further large-scale studies to evaluate arrhythmia in MWA patients, and bring into question whether routine screening for arrhythmia is of benefit for stroke prevention in select migraine patients.