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Meta-Analysis
. 2010 Jul;123(7):612-24.
doi: 10.1016/j.amjmed.2009.12.021. Epub 2010 May 20.

Migraine headache and ischemic stroke risk: an updated meta-analysis

June T Spector  1 , Susan R Kahn, Miranda R Jones, Monisha Jayakumar, Deepan Dalal, Saman Nazarian
Affiliations
Meta-Analysis

Migraine headache and ischemic stroke risk: an updated meta-analysis

June T Spector et al. Am J Med. 2010 Jul.

Abstract

Background: Observational studies, including recent large cohort studies that were unavailable for prior meta-analysis, have suggested an association between migraine headache and ischemic stroke. We performed an updated meta-analysis to quantitatively summarize the strength of association between migraine and ischemic stroke risk.

Methods: We systematically searched electronic databases, including MEDLINE and EMBASE, through February 2009 for studies of human subjects in the English language. Study selection using a priori selection criteria, data extraction, and assessment of study quality were conducted independently by reviewer pairs using standardized forms.

Results: Twenty-one (60%) of 35 studies met the selection criteria, for a total of 622,381 participants (13 case-control, 8 cohort studies) included in the meta-analysis. The pooled adjusted odds ratio of ischemic stroke comparing migraineurs with nonmigraineurs using a random effects model was 2.30 (95% confidence interval [CI], 1.91-2.76). The pooled adjusted effect estimates for studies that reported relative risks and hazard ratios, respectively, were 2.41 (95% CI, 1.81-3.20) and 1.52 (95% CI, 0.99-2.35). The overall pooled effect estimate was 2.04 (95% CI, 1.72-2.43). Results were robust to sensitivity analyses excluding lower quality studies.

Conclusions: Migraine is associated with increased ischemic stroke risk. These findings underscore the importance of identifying high-risk migraineurs with other modifiable stroke risk factors. Future studies of the effect of migraine treatment and modifiable risk factor reduction on stroke risk in migraineurs are warranted.

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Figures

Figure 1
Figure 1
Selection Process for Study Inclusion in the Meta-Analysis.
Figure 2A
Figure 2A. Methodological Quality Summary for 14 Case-Control Studies
Colors in table correspond to reviewers’ consensus answers to questions at the top of the figure for each study, with green indciating “yes”, yellow indicating “uncertain”, and red indicating “no”.
Figure 2B
Figure 2B. Methodological Quality Summary for 8 Cohort Studies
Colors in table correspond to reviewers’ consensus answers to questions at the top of the figure for each study, with green indciating “yes”, yellow indicating “uncertain”, and red indicating “no”. LTFU indicates loss to follow-up.
Figures 3A
Figures 3A. Adjusted Effect Estimates of Ischemic Stroke in Participants With Any Migraine Versus No Migraine
Size of data markers indicates weight of study.
Figures 3B
Figures 3B. Adjusted Effect Estimates of Ischemic Stroke in Participants with Migraine With Aura Versus No Migraine
Size of data markers indicates weight of study.
Figures 3C
Figures 3C. Adjusted Effect Estimates of Ischemic Stroke in Participants with Migraine Without Aura Versus No Migraine
Size of data markers indicates weight of study.
Figures 3D
Figures 3D. Adjusted Effect Estimates of Ischemic Stroke in Studies of Only Women Participants with Any Migraine Versus No Migraine
Size of data markers indicates weight of study.
Figures 3E
Figures 3E. Adjusted Effect Estimates of Ischemic Stroke in Low Bias Studies in Participants With Any Migraine Versus No Migraine
Size of data markers indicates weight of study.
Figure 4
Figure 4. Influence of Removing Studies One By One on Adjusted Effect Estimates of Ischemic Stroke
Circles are effect estimates and horizontal dotted lines 95% confidence intervals for meta-analysis of the studies listed, excluding the study indicated by the circle. The vertical line in the center is the summary effect estimate including all listed studies.
Figure 5
Figure 5. Funnel Plot of Studies Reporting Adjusted Odds Ratios
Plots are log standard error of effect estimate by adjusted effect estimate, centered on the pooled adjusted effect estimate. The pseudo 95% confidence interval corresponds to the expected 95% confidence interval for a given standard error. OR indicates odds ratio.
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Comment in

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