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Multicenter Study
. 2017 May 1;74(5):512-518.
doi: 10.1001/jamaneurol.2016.5704.

Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults

Valeria De Giuli  1 , Mario Grassi  2 , Corrado Lodigiani  3 , Rosalba Patella  4 , Marialuisa Zedde  5 , Carlo Gandolfo  6 , Andrea Zini  7 , Maria Luisa DeLodovici  8 , Maurizio Paciaroni  9 , Massimo Del Sette  10 , Cristiano Azzini  11 , Antonella Toriello  12 , Rossella Musolino  13 , Rocco Salvatore Calabrò  14 , Paolo Bovi  15 , Maria Sessa  16 , Alessandro Adami  17 , Giorgio Silvestrelli  18 , Anna Cavallini  19 , Simona Marcheselli  20 , Domenico Marco Bonifati  21 , Nicoletta Checcarelli  22 , Lucia Tancredi  23 , Alberto Chiti  24 , Enrico Maria Lotti  25 , Elisabetta Del Zotto  26 , Giampaolo Tomelleri  15 , Alessandra Spalloni  4 , Elisa Giorli  27 , Paolo Costa  1 , Loris Poli  1 , Andrea Morotti  1 , Filomena Caria  1 , Alessia Lanari  18 , Giacomo Giacalone  28 , Paola Ferrazzi  3 , Alessia Giossi  16 , Valeria Piras  29 , Davide Massucco  6 , Cataldo D'Amore  9 , Filomena Di Lisi  4 , Ilaria Casetta  11 , Laura Cucurachi  30 , Masina Cotroneo  13 , Alessandro De Vito  11 , Elisa Coloberti  20 , Maurizia Rasura  4 , Anna Maria Simone  7 , Massimo Gamba  31 , Paolo Cerrato  32 , Giuseppe Micieli  33 , Giovanni Malferrari  5 , Maurizio Melis  29 , Licia Iacoviello  34 , Alessandro Padovani  1 , Alessandro Pezzini  1 ; Italian Project on Stroke in Young Adults Investigators
Affiliations
Multicenter Study

Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults

Valeria De Giuli et al. JAMA Neurol. .

Abstract

Importance: Although sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS).

Objective: To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.

Design, setting, and participants: A prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine.

Main outcomes and measures: Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS.

Results: Of the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P < .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95% CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95% CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95% CI, 1.22-2.71). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P > .99).

Conclusions and relevance: In patients with IS aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with CEAD. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

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