Migraine appears to be a key risk factor for stroke, a new study has found.
Strokes are serious vascular events that can sometimes result in death, and other times lead to varying levels of disability.
- Because of its severity,
researchers want to continue identifying risk factors to help reduce
stroke risk.
- A recent study highlighted the
impact of nontraditional risk factors on stroke outcomes. It found that
nontraditional risk factors — such as migraine and thrombophilia, a
condition that predisposes a person to the formation of blood clots —
played a crucial role in stroke risk, and contributed more to stroke risk
in adults aged under 35 compared with traditional risk factors.
Stroke prevention
is a crucial area of preventative health measures. Because of the dangers of
strokes, people must know if they are at risk and what they may be able to do
to modify their risk.
While younger individuals typically have a lower stroke risk,
it is still important to note what risk factors affect younger populations,
particularly as the consequences of a stroke can be lifelong.
A study recently published in Circulation: Cardiovascular Quality and Outcomes examined
how nontraditional and traditional risk factors for stroke contributed to
stroke in younger adults.
Researchers examined data from over 2,600 stroke cases and
over 7,800 controls and examined how traditional and nontraditional risk
factors contributed to stroke risk in adults aged 55 and younger.
The study found that nontraditional risk factors contributed
to strokes most in adults under 35, and the risks from these nontraditional
factors declined with age. These results highlight the importance of
identifying nontraditional stroke risk factors, particularly among younger
adults.
Stroke impact and
risk factors
Stroke is such a dangerous health event because it can lead to brain
damage. There are two main types of strokes: ischemic
and hemorrhagic. In an ischemic stroke, there is some kind of blockage of
the brain’s blood supply. In a hemorrhagic stroke, bleeding occurs in the
brain, such as from a ruptured artery.
Multiple risk
factors can increase someone’s odds of experiencing a stroke,
including having high
blood pressure, diabetes, low
levels of physical activity, and smoking.
Having a family history of stroke or an AB blood type can
also increase risk. People can seek medical advice and guidance to help them
determine their level of stroke risk.
The current researchers wanted to focus on some of the more
nontraditional risk factors for stroke. They created the following breakdown
for their research.
Traditional vascular risk factors included:
- high blood
pressure
- diabetes
- high cholesterol
- sleep apnea
- obesity
- alcohol use
disorder and substance
use disorder
- tobacco use
- peripheral artery
disease, coronary artery
disease, and congestive heart
failure.
Nontraditional risk factors included:
- pregnancy
and postpartum period
- use of oral
contraceptives
- migraine
- malignancy, HIV, and hepatitis
- thrombophilia,
which increases the risk of blood clots
- autoimmune
diseases, vasculitis,
and sickle
cell disease
- heart
valve disorders
- kidney failure.
How do
nontraditional factors contribute to stroke risk?
This study was a retrospective case-control study, where
researchers collected data from the Colorado All Payer Claims Database.
Researchers analyzed models stratified by age and biological
sex to look at traditional and nontraditional stroke risk factors. This
ultimately divided participants into three age group categories:
- 18–34-year-olds
- 35–44-year-olds
- 45–55-year-olds.
There were 2,628 stroke cases during the examined timeframe.
Of this number, 73.3% were ischemic strokes,
and 52% occurred in women. Researchers compared these stroke cases to 7,827
controls.
Researchers were more likely to see traditional risk factors
linked to the stroke cases. The most common traditional risk factors they
observed were high
blood pressure, hyperlipidemia, and
tobacco use.
Among men, the most common nontraditional risk factors were
migraine, kidney failure, and thrombophilia. Among women, the most common
nontraditional risk factors were migraine, thrombophilia, and malignancy —
which refers to conditions where mutated cells invade healthy tissue.
Researchers further found that nontraditional risk factors
contributed more to stroke risk in the youngest age group than traditional risk
factors.
Among 18–34-year-olds, 31.4% of strokes among men and 42.7%
of strokes among women were associated with nontraditional risk factors.
In contrast, traditional risk factors accounted for 25.3% of
strokes among men and 33.3% of strokes among women. Researchers also found that
the contributing risk from traditional factors peaked among participants in the
35–44-year-old category and that risk from nontraditional factors decreased
with age.
Study author Michelle
Hu Leppert, MD, MBA, assistant professor in the Department of Neurology at
the University of Colorado School of Medicine, outlined the highlights of the
research to Medical News Today:
“We wanted to better understand which
risk factors were the most important contributors to stroke risk among young
adults. We found that among adults 18 to 34 years of age, nontraditional risk
factors were just as important as traditional risk factors. In fact, the
younger the patient at the time of stroke, the more likely their stroke [was to
occur] due to a nontraditional risk factor. We were surprised to find that
migraine was the most important nontraditional stroke risk factor among adults
[aged] 18 to 34 […] The association between migraine and strokes has been well
established but this is the first study to show just how large this
contribution could [be].”
The results do point to the importance of screening for
nontraditional risk factors for stroke, particularly among younger individuals.
Adi Iyer, MD, neurosurgeon and interventional
neuroradiologist at Pacific Neuroscience Institute at Providence Saint John’s
Health Center in Santa Monica, CA, not involved in the research, commented
that, “[i]n addition to well known risk factors for stroke such as
hypertension, this study elucidated the lesser-known risk factors in young
patients such as migraines, autoimmune disorders and thrombophilia.”
“This is an interesting study as it helps identify risk
factors in young patients for stroke, which turn out to be just as important as
already well understood risk factors such as hypertension and heart disease,”
he told us.
“Younger patients with nontraditional risk factors such as
autoimmune disorders, migraine, and thrombophilia should be screened by
physicians for their stroke risk,” Iyer advised.
Unclear
why migraine may lead to stroke
While this research brought some crucial information about
stroke risk factors to light, the authors nevertheless outlined certain
limitations to their study.
First of all, because of how researchers identified risk
factors, they did not account for uncoded diagnoses or risk factors when
participants did not seek care.
Secondly, there is some risk for unmeasured bias and residual
confounding. It is possible that the risk from certain factors was not
adequately captured because of how researchers conducted the study.
The research also did not focus on every potential stroke risk
factor, and researchers noted that their assessment of nontraditional risk
factors may actually be an underestimate.
The study authors further cautioned that the results may not
be generalizable because the study was conducted in a claims database in Colorado,
which has a higher altitude, which may have affected the study sample. For
example, the altitude could trigger a sickle
cell pain crisis. This might explain why there was a low number of
participants with sickle cell disease.
Finally, the researchers acknowledged that they could not
account for certain confounders and had some missing data on race and
ethnicity.
Thus, researchers encouraged the replication of the study in
different population-based cohorts to gather more data.
Leppert told MNT:
“We found that the potential
contribution of migraine headaches to the development of strokes in young
adults is large. However, we do not know why migraine [attacks] lead to strokes
in the first place. There is currently no clinical treatment to prevent strokes
in migraineurs. Developing a better understanding of the mechanisms of
migraines which lead to strokes can help us to develop future clinical
interventions.”
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