Changes in Migraine Symptoms after Ischemic Stroke: A Cohort Study

Cerebrovascular Diseases, vol. 54, pp. 344–349

Abstract

INTRODUCTION: Migraine symptoms are postulated to improve post-stroke. We aimed to determine post-stroke changes in patients with active migraine pre-stroke and explored the relation with stroke location and stroke-preventive medication use. METHODS: Patients with active migraine who had an ischemic stroke were retrieved from three research-cohorts between 2014 and 2021. By an interview, we retrospectively investigated first-year post-stroke changes for those ischemic stroke patients that suffered from migraine pre-stroke. Associations between change in migraine frequency/intensity/aura (decrease, no change, increase), stroke location (posterior location vs. other), and use of secondary stroke preventive medication were assessed by ordinal regression with adjustment for confounders. RESULTS: We included 78 patients (mean age 48 years, 86% women, 47% with aura). Change in migraine symptomatology was reported by 63 (81%) patients; 51 (81%) noticed a decrease in attack frequency (27 no attacks) and 12 (19%) an increase. Pain intensity change was reported by 18 (35%) patients (50% increase, 50% decrease). Aura symptomatology improved in 4 (11%). Reduced attack frequency was not related to posterior stroke (OR = 1.5, 95% CI: 0.6-3.9), or preventive medication (antiplatelets OR = 1.0, 95% CI: 0.2-3.7; coumarin OR = 2.7, 95% CI: 0.4-20.6). CONCLUSIONS: Most patients with active pre-stroke migraine experience improvement of their symptoms in the first year after ischemic stroke. This change does not seem to be related to secondary stroke preventive medication or posterior stroke location.

Authors 11

1. Nelleke van der Weerd Aachen Department of Human Genetics Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands

   Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands

2. Nadine Pelzer Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands

3. Emma Egberts Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands

4. Marit Mertens Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands

5. Willemijn Bakker Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands

6. Katie M. Linstra Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands

7. Arn M. J. M. van den Maagdenberg Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands

8. Erik W. van Zwet Aachen Department of Medical Statistics

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands

9. Antoinette MaassenVanDenBrink

   Erasmus MC

   Affiliation as printed

   Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands

10. Gisela Marie Terwindt Aachen Department of Neurology, Leiden University Medical Centre

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands

11. Marieke J.H. Wermer Aachen Department of Neurology, Leiden University Medical Centre

    Leiden University · University Medical Center Groningen · Leiden University Medical Center

    Affiliation as printed

    Department of Neurology, Groningen University Medical Centre, Groningen, The Netherlands

    Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands