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. 2025 Feb 19;26(1):37.
doi: 10.1186/s10194-025-01975-8.

Stroke etiology and white matter burden in women with and without migraine

Anne E Wilms  1 , Nelleke van der Weerd  1   2 , Thijs W van Harten  3   4 , Katie M Linstra  1   5 , Hendrikus J A van Os  6 , Irene de Boer  1 , Mark C Kruit  3 , Antoinette Maassen van den Brink #  5 , Marieke J H Wermer #  1   7 , Gisela M Terwindt #  8 ; CREW consortium
Collaborators, Affiliations

Stroke etiology and white matter burden in women with and without migraine

Anne E Wilms et al. J Headache Pain. .

Abstract

Background: Women with migraine, especially with aura (MA), have a higher risk of white matter hyperintensities (WMH) and ischemic stroke. We aimed to assess differences in stroke etiology between women with and without migraine and the impact of migraine on WMH volume in women with stroke.

Methods: We included women aged 40-60 years with a history of ischemic stroke, migraine or both. Stroke etiology was categorized using the TOAST criteria. WMH volume was measured using 3D-FLAIR images. Presence or absence of cerebellar WMH was scored. We used regression analysis to assess differences between groups, with adjustments for age, BMI, hypertension and smoking status.

Results: We included 55 women with stroke, 55 with stroke and migraine, and 38 with MA. Women with stroke more often had a history of smoking than those with stroke and migraine (74% vs. 46%, p = 0.004). Stroke of undetermined origin was more common in women with both conditions than with stroke alone (49% vs. 27%, p = 0.019). Periventricular WMH volumes were higher in women with stroke with migraine than in those with MA alone (0.55mL vs. 0.42mL, B = 0.21, 95%CI = 0.01-0.41, p = 0.040). There were no differences in deep WMH volume and cerebellar WMH between groups. Importantly, the addition of migraine did not affect WMH volume in women who had experienced stroke.

Conclusion: Women with both stroke and migraine more often had undetermined etiology of stroke compared to women with stroke alone, and in women with stroke alone smoking was a more prevalent risk factor. Migraine did not contribute to increased WMH volume in women with stroke.

Keywords: Cerebrovascular; Headache; MRI; Migraine; Smoking; Stroke; White matter hyperintensities (WMH).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Medical Ethics Committee Leiden - Den Haag - Delft (METC-LDD) approved the CREW-MIST (P15.384) and WHISPER (P18.130) study protocols and all participants provided written informed consent prior to study participation. Competing interests: NW, KL and HO report no disclosures. MW was supported by personal grants from the Netherlands Organization for Scientific Research (VIDI Grant no. 91717337 and Aspasia grant). TH received support from the Dutch Heart Foundation and the Netherlands Organisation for Scientific Research (NWO), as part of their joint strategic research programme: “Earlier recognition of cardiovascular diseases”. AW and GT and IB report grant support by the European Community (101070917), Stichting Dioraphte (20010407), and the Clayco foundation. In addition, IB reports independent research support from the Dutch Heart Foundation (2020T065), and GT reports additional grants or consultancy support from Abbvie, Novartis, Lilly, Lundbeck, Organon, Pfizer, Teva, and independent support from the Dutch Research Council, Heart Foundation, Dutch Brain Foundation. AMB received honoraria and research/travel grants from Allergan/AbbVie, Amgen/Novartis, Eli Lilly, Pfizer, Satsuma, Teva, and Tonix, and independent support from the Dutch Research Council and ZonMw.

Figures

Fig. 1
Fig. 1
Differences in cardiovascular risk factors (hypertension (A), hypercholesterolemia (B), ever smoking (C), and overweight (D)) between women with a history of stroke, stroke and migraine, and migraine with aura. Only significant p-values are depicted
Fig. 2
Fig. 2
TOAST classification of women with a stroke with and without migraine. Women with stroke and migraine more often had a stroke of undetermined origin (p = 0.019). Only significant p-values are depicted. Abbreviations: TOAST classification = Trial of Org 10172 in acute stroke treatment classification
Fig. 3
Fig. 3
Median white matter hyperintensities (WMH) volumes (IQR) of women with a history stroke, stroke and migraine, and migraine with aura. P-values are derived from linear regression analyses of log-transformed volumes and are corrected for age, BMI, hypertension and smoking status
Fig. 4
Fig. 4
Example of white matter hyperintensities (WMH) on 3D fluid-attenuated inversion recovery (FLAIR) images of three women: A a woman with migraine with aura, the arrow marks a deep WMH; B a woman with a history of stroke, the arrow marks a deep WMH, the asterisks mark the area affected by the stroke; C a woman with a history of migraine and stroke (stroke lesions not depicted on image)
See this image and copyright information in PMC

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