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Stroke and Chest Pain in Young People With Migraine
Article first published online: 21 FEB 2006
Headache: The Journal of Head and Face Pain
Volume 46, Issue 2, pages 208–211, February 2006
How to Cite
Hoffmann, M. (2006), Stroke and Chest Pain in Young People With Migraine. Headache: The Journal of Head and Face Pain, 46: 208–211. doi: 10.1111/j.1526-4610.2006.00333.x
From the Department of Neurology, University of South Florida, Tampa, Florida.
- Issue published online: 21 FEB 2006
- Article first published online: 21 FEB 2006
- Accepted for publication June 7, 2005.
- chest pain
Background.—Cerebrovascular and cardiovascular complications in migraineurs may be part of the migraine process and also consequent to triptan treatment
Aim.—To determine the frequency, subtypes and associations of migraine-associated stroke and angina in young people (18–49 years).
Methods.—Patients were derived from a tertiary referral migraine and stroke registry. Migraine-associated stroke was classified according to the four groups described by Welch and by the TOAST etiological stroke classification. A clinical description of angina during a migraine attack was required for the diagnosis of cardiac migraine without concomitant triptan or other vasoactive medications
Results.—Of the young patients with stroke (349/1316; 26.5%), there were 30 (30/349; 8.6%) who had migraine at the time of stroke when categorized by the Welch classification type II to IV (type II n = 5, type III n = 2, type IV n = 3). Comparison of type I (n = 20) versus types II–IV (n = 10) showed significant difference (P= .03). Topographically the lesions were distributed into the partial anterior circulation (n = 8) and posterior circulation (n = 2) (P= .04). Comparison of anterior and posterior circulation territories of infarction indicated significant difference (n = 26/30 and 4/30; P= .01). The stroke etiological subtypes included cardiogenic (n = 5), atherogenic (n = 15), other (n = 5), and unknown (n = 5), with none diagnosed with small-vessel cerebrovascular disease. Traditional stroke mechanistic entities (cardiac and atherogenic) differed significantly in comparison to the other and unknown categories P= .05. Cardiovascular patients with angina during a migraine attack (n = 9/1040; 0.9%), included IHS subtypes; migraine without aura (n = 4), migraine with aura (n = 4), and complicated migraine (n = 1). One patient required cardiac catheterization on account of significant ECG changes, with documented, reversible vasospasm.
Conclusion.—(i) Migraine-induced stroke remains controversial, with only two probable cases of type Welch III A+B in a large registry. (ii) Cardiac migraine may be a distinct entity requiring careful differentiation from triptan-induced chest pain.