Sex differences in risk profile, stroke cause and outcome in ischemic stroke patients with and without migraine

Linstra, K.M.; Os, H.J.A. van; Ruigrok, Y.M.; Nederkoorn, P.J.; Dijk, E.J. van; Kappelle, L.J.; ... ; Dutch Parelsnoer Inst Stroke Study (2021)

Article / Letter to editor

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.

• sex differences
• migraine
• stroke outcome
• stroke subtype
• cardiovascular risk factors

• All authors: Linstra, K.M.; Os, H.J.A. van; Ruigrok, Y.M.; Nederkoorn, P.J.; Dijk, E.J. van; Kappelle, L.J.; Koudstaal, P.J.; Visser, M.C.; Ferrari, M.D.; MaassenVanDenBrink, A.; Terwindt, G.M.; Wermer, M.J.H.; Dutch Parelsnoer Inst Stroke Study
• Date: 2021-11-03
• Journal: Frontiers in Neuroscience
• Volume: 15
• DOI: doi:10.3389/fnins.2021.740639
• Link: https://www.frontiersin.org/articles/10.3389/fnins.2021.740639/pdf