Evidence-based evaluation of the primary prevention of stroke in migraineurs

Abstract

Objective To evaluate the evidence of migraine increasing the risk of stroke, so as to provide evidence-based foundation for primary prevention of stroke in patients with migraine.  Methods Taking migraine or migraine with aura, prevention and control, ischemia, hemorrhagic stroke, treatment or therapy as search terms, retrieve in databases such as PubMed and ScienceDirect, assisted by manual searching, in order to collect relevant literatures including clinical guidelines, systematic reviews, Meta-analysis, randomized controlled trials, clinical controlled trials, retrospective case analysis, case-observation studies and reviews. Jadad Scale was used to evaluate the quality of literature.  Results Twenty-four related articles were finally selected, including 5 clinical guidelines, 2 systematic reviews, 4 Meta-analyses, 2 randomized controlled trials, 10 case-observation studies and 1 review. Among them 20 were of high quality, while 4 were of low quality. The results were as follows: 1) migraine, particularly migraine with aura, significantly increased the risk of ischemic stroke, and the risk of women was higher than men. Smoking and oral contraceptives further increased the risk of stroke. 2) The risk of hemorrhagic stroke in migraine with aura patients was higher than that in general population. Migraine without aura did not appear to increase the risk of hemorrhagic stroke, and migraine was an independent risk factor for aneurysm rupture. 3) Frequency of migraine attacks, especially migraine with aura, and risk of ischemic stroke was positively correlated. 4) Patent foramen ovale (PFO) was more common in young patients with cryptogenic stroke and migraineurs. However, closure of PFO was not indicated for preventing stroke in migraineurs. 5) Triptans, which was used to treat acute migraine, with a vasoconstrictor effect, may increase the risk of stroke, therefore prophylactic treatment of migraine was very important.  Conclusions Smoking cessation and alternatives to oral contraceptives are recommended in women with migraine. Treatment to reduce migraine frequency might be reasonable, however, there is no evidence showing that this treatment approach would reduce the risk of first stroke. Due to the vasoconstrictor effect of triptans, prophylactic treatment should be the priority of migraineurs.

DOI: 10.3969/j.issn.1672-6731.2015.01.008