Migraine may not be a risk factor for stroke

The idea of migraine being a risk factor for stroke should be reconsidered, especially for the middle-aged and elderly population. In this study, no association was found with any type of stroke or ischaemic stroke specifically [1]. Moreover, no sex differences were found in the concerning population-based cohort study, nor differences between migraine with versus without aura, active versus non-active migraine.

Migraine and stroke are neurovascular disorders causing a significant burden on both patients and the economy. A potential causal link between migraine and stroke has been suggested, but several knowledge gaps remain.

The current study is based on an ongoing prospective population-based cohort study, called the Rotterdam Study, which investigates the determinants and occurrence of cardiovascular, neurological, ophthalmological, psychiatric, and endocrine diseases [1]. “In different cohorts, we assessed the baseline migraine between 2006 and 2011 and followed those participants for the occurrence of stroke,” Mr Cevdet Acarsoy (Erasmus Medical Centre, the Netherlands) explained.

Prevalent migraine was determined at baseline in an interview with a qualified physician and verified from medical records. Then, participants were continuously monitored for incident strokes by means of linking study databases with files from general practitioners or nursing home records. Additionally, imaging reports were obtained from hospital reports, to ascertain stroke subtypes as ischaemic, haemorrhagic, or unspecified.

Included were 6,925 participants (mean age 65.7, 57.8% women) who did not suffer from a previous stroke. At baseline, 1,030 (14.9%) participants met the criteria for migraine, of whom 402 had active migraine and 210 had migraine with aura.

After a median follow-up of 6.4 years, 195 participants suffered a stroke. Follow-up was complete for 95.3% of potential person-years. “Although we found a trend for an association between migraine and stroke (HR 1.40), this association was not statistically significant (P=0.83; see Figure),” Mr Acarsoy said.

Figure: Kaplan-Meier survival curves for the probability of stroke-free survival in individuals with or without migraine [1]



When repeating the analysis for the different subtypes of migraine, results remained consistent:

• active versus non-active, HR 1.59; and


• aura present versus absent, HR 1.45.

Moreover, concerning stroke subtypes, the investigators found no significant association with ischaemic stroke (HR 1.45).

1. Acarsoy C, et al. Migraine is not Associated with Incident Stroke: The Rotterdam Study. AL016, IHC 2021, 8–12 September.

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Posted on 8 November, 20219 February, 2022