Abstract WP241: Migraine Associated Risk of Stroke Score

Abstract

Background: Migraine with aura is a risk factor for ischemic stroke. We refined the migraine with aura risk score (MARS) to create the migraine associated risk of stroke score (MARS Plus) making it applicable to migraine with and without aura. The expanded risk score includes vascular risk factors, migraine characteristics, and medications used in migraine patients. Methods: We prospectively evaluated participants in Atherosclerosis Risk in Communities Cohort (ARIC) with history of migraine. In this population, we tested the association of potential risk factors for ischemic stroke using a Cox proportional-hazards model. The coefficient of each variable was divided by the lowest β value and rounded to the nearest integer. The sum of the weighted score of the reported risk factors was found and was categorized into two prognostic groups. Results: We assessed migraine characteristics (aura, migraine frequency and duration) and medications (ergot alkaloids, triptans, hormone replacement therapy, sympathomimetics and steroids) in addition to traditional risk factors. Based on the points derived from the significant factors we assigned age≥65 =2, non-white race=2, hypertension=3, diabetes=4, body mass index ≥30 =2, coronary artery disease =2, atrial fibrillation =3, alcohol use=1, steroids=3 and presence of aura=2 to total 24 points. Cut-off of MARS Plus ≥5 was considered high risk for ischemic stroke based on receiver operating characteristic (ROC) curve and Youden’s index (Figure). Of the 1485 migraineurs, 112 had an ischemic stroke. MARS Plus ≥5 revealed a hazard ratio of 4.29 (95% CI 2.86-6.45) as shown in the Kaplan-Meier Survival Curve. Conclusion: The new MARS Plus is used to predict ischemic stroke in patients with migraine with and without aura. This new risk score, in addition to generalizability, includes factors such as migraine characteristics and medications that may increase stroke risk.