AUTHOR=Linstra Katie M. , van Os Hendrikus J. A. , Ruigrok Ynte M. , Nederkoorn Paul J. , van Dijk Ewoud J. , Kappelle L. Jaap , Koudstaal Peter J. , Visser Marieke C. , Ferrari Michel D. , MaassenVanDenBrink Antoinette , Terwindt Gisela M. , Wermer Marieke J. H.
TITLE=Sex Differences in Risk Profile, Stroke Cause and Outcome in Ischemic Stroke Patients With and Without Migraine
JOURNAL=Frontiers in Neuroscience
VOLUME=15
YEAR=2021
URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2021.740639
DOI=10.3389/fnins.2021.740639
ISSN=1662-453X
ABSTRACT=Background: An increased risk of stroke in patients with migraine has been primarily found for women. The sex-dependent mechanisms underlying the migraine–stroke association, however, remain unknown. This study aims to explore these sex differences to improve our understanding of pathophysiological mechanisms behind the migraine–stroke association.
Methods: We included 2,492 patients with ischemic stroke from the prospective multicenter Dutch Parelsnoer Institute Initiative study, 425 (17%) of whom had a history of migraine. Cardiovascular risk profile, stroke cause (TOAST classification), and outcome [modified Rankin scale (mRS) at 3 months] were compared with both sexes between patients with and without migraine.
Results: A history of migraine was not associated with sex differences in the prevalence of conventional cardiovascular risk factors. Women with migraine had an increased risk of stroke at young age (onset < 50 years) compared with women without migraine (RR: 1.7; 95% CI: 1.3–2.3). Men with migraine tended to have more often stroke in the TOAST category other determined etiology (RR: 1.7; 95% CI: 1.0–2.7) in comparison with men without migraine, whereas this increase was not found in women with migraine. Stroke outcome was similar for women with or without migraine (mRS ≥ 3 RR 1.1; 95% CI 0.7–1.5), whereas men seemed to have a higher risk of poor outcome compared with their counterparts without migraine (mRS ≥ 3 RR: 1.5; 95% CI: 1.0–2.1).
Conclusion: Our results indicate possible sex differences in the pathophysiology underlying the migraine–stroke association, which are unrelated to conventional cardiovascular risk factors. Further research in larger cohorts is needed to validate these findings.