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Keywords:

  • stroke;
  • migraine;
  • 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.