Abstract
BackgroundIdentifying migraineurs by triptan utilization we studied risk for stroke in migraineurs compared to the general population. MethodsA cohort study including all citizens 25–80years of age in Denmark 2003–2011 was conducted. All persons prescribed triptans, and all those hospitalized for a first stroke were identified in the Danish Registries. Information on stroke severity/subtype and cardiovascular risk factors was available for stroke patients. FindingsOf the 49,711 patients hospitalized for a first stroke, 1084 were migraineurs using triptans. Adjusting for age, sex, income, and educational level, risk for stroke was higher among migraineurs in respect to all strokes (RR 1.07; CI 1.01–1.14) and ischemic strokes (RR 1.07; CI 1.00–1.14). Risk for hemorrhagic stroke was increased but only in women (RR 1.41; CI 1.11–1.79). Risk was for mild strokes (RR 1.31; CI 1.16–1.48) while risk for severe strokes was lower among migraineurs (RR 0.77; CI 0.65–0.91). Risk was age-related; highest among women 25–45years (RR≈1.7). Risk was unrelated to numbers of dispensations. InterpretationMigraineurs identified by triptan utilization had higher risk for stroke. Strokes were minor and cardiovascular risk factors were less prevalent pointing to a migraine-specific etiology of stroke different from that of thromboembolism.
Highlights
Migraine is associated with a two-fold increased relative risk for stroke (Etminan et al, 2005; Schurks et al, 2009; Spector et al, 2010)
As an alternative way of establishing a sizeable cohort of migraine patients with stroke we identified migraine through triptan utilization
We evaluated the effect modification in the risk of stroke in migraine identified through triptan utilization with respect to ischemic stroke vs. hemorrhagic stroke and among stroke severity categories
Summary
Migraine is associated with a two-fold increased relative risk for stroke (Etminan et al, 2005; Schurks et al, 2009; Spector et al, 2010). Etiology of stroke in migraine remains still obscure (Kurth and Diener, 2012). Studies relate migraine to hemorrhagic stroke but they are too few and too small to make conclusions about etiology (Sacco et al, 2013; Kurth and Tzourio, 2013). As an alternative way of establishing a sizeable cohort of migraine patients with stroke we identified migraine through triptan utilization. Based on this cohort the purpose of this study was to estimate risk of stroke and to characterize strokes by age, sex, subtype and severity in. Identifying migraineurs by triptan utilization we studied risk for stroke in migraineurs compared to the general population. Interpretation: Migraineurs identified by triptan utilization had higher risk for stroke. Strokes were minor and cardiovascular risk factors were less prevalent pointing to a migraine-specific etiology of stroke different from that of thromboembolism
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