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Neurology
Research
Risk of ischaemic stroke in patients with migraine: a longitudinal follow-up study using a national sample cohort in South Korea
  1. Sang-Yeon Lee1,
  2. Jae-Sung Lim2,
  3. Dong Jun Oh3,
  4. Il Gyu Kong,
  5. Hyo Geun Choi4
  1. 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Jongno-gu, The Republic of Korea
  2. 2Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, The Republic of Korea
  3. 3Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul-si, The Republic of Korea
  4. 4Department of Laboratory Medicine, HallymUniversity Sacred Heart Hospital, Anyang, The Republic of Korea
  1. Correspondence to Dr Hyo Geun Choi; pupen{at}naver.com

Abstract

Objective Accumulating evidence has supported the association between migraine and stroke, but the causative association remains unclear. We aimed to investigate the risks of different types of stroke in patients with migraine.

Design A longitudinal follow-up study.

Setting Data collected from a national cohort between 2002 and 2013 by the South Korea Health Insurance Review and Assessment.

Participants We extracted the data from patients with migraine (n=41 585) and 1:4 matched controls (n=1 66 340) and analysed the occurrence of ischaemic and haemorrhagic strokes. The migraine group included participants treated for migraine (International Classification of Disease-10 (ICD-10): G43)≥2 times. Haemorrhagic stroke (I60-I62) and ischaemic stroke (I63) were determined based on the admission histories. The crude and adjusted HRs were calculated using Cox proportional hazard models, and the 95% CI were determined. Subgroup analyses stratified by age and sex were also performed.

Results Higher rates of ischaemic stroke were observed in the migraine group (2.3% [964/41,585]) than in the control group (2.0% [3294/166 340], P<0.001). The adjusted HR for ischaemic stroke was 1.18 (95% CI=1.10 to 1.26) in the migraine group (P<0.001). Compared with control subjects, participants who reported migraine with aura and migraine without aura had increased adjusted HRs of 1.44 (95% CI=1.09 to 1.89) and 1.15 (95% CI=1.06 to 1.24), respectively, for ischaemic stroke, but no increased risk of haemorrhagic stroke. In our subgroup analysis, a strong association between migraine and ischaemic stroke was observed in young patients, specifically young women. The contribution of migraine to the occurrence of ischaemic stroke was also observed in middle-aged women and old women (each P<0.05). The risk of haemorrhagic stroke did not reach statistical significance in any age group.

Conclusion Migraine is associated with an increased risk of ischaemic stroke, but not haemorrhagic stroke.

  • migraine
  • stroke
  • cohort study
  • Korea

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-027701

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    Footnotes

    • Contributors As the first author, S-YL wrote the manuscript. DJO and J-SL analysed and interpreted the data. IGK processed the data. HGC conceptualised, wrote and reviewed the manuscript.

    • Funding This work was supported by the Hallym University Research Fund and in part by a research grant (NRF-2015-R1D1A1A01060860) from the National Research Foundation (NRF) of Korea.

    • Competing interests None declared.

    • Ethics approval The ethics committee of Hallym University (2014-I148) approved the use of these data.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea.

    • Patient consent for publication Not required.