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From the Divisions of Preventive Medicine (Drs. Kurth, Cook, Lee, Gaziano, and Buring) and Aging (Drs. Kurth, Gaziano, and Buring), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Department of Epidemiology (Drs. Kurth, Cook, Lee, and Buring), Harvard School of Public Health, Department of Ambulatory Care and Prevention (Dr. Buring), Harvard Medical School, and Department of Neurology (Dr. Kase), Boston University Medical Center, Boston, MA; and School of Medicine (M.A. Slomke) and Department of Neurology (Dr. Diener), University Duisburg–Essen, Essen, Germany.
Address correspondence and reprint requests to Dr. T. Kurth, Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave. E., Boston, MA 02215-1204; e-mail: tkurth{at}rics.bwh.harvard.edu
Background: Migraine and headache in general have been associated with subsequent risk of stroke, primarily in retrospective case-control studies. Prospective data evaluating the association between specific headache forms and stroke are sparse.
Methods: A prospective cohort study was conducted among 39,754 US health professionals age 45 and older participating in the Women’s Health Study with an average follow-up of 9 years. Incident stroke was self-reported and confirmed by medical record review.
Results: A total of 385 strokes (309 ischemic, 72 hemorrhagic, and 4 undefined) occurred. Compared with nonmigraineurs, participants who reported migraine overall or migraine without aura had no increased risk of any stroke type. Participants who reported migraine with aura had increased adjusted hazards ratios (HRs) of 1.53 (95% CI 1.02 to 2.31) for total stroke and 1.71 (95% CI 1.11 to 2.66) for ischemic stroke but no increased risk for hemorrhagic stroke. Participants with migraine with aura who were <55 years old had a greater increase in risk of total (HR 1.75; 95% CI 1.02 to 3.00) and ischemic (HR 2.25; 95% CI 1.30 to 3.91) stroke. Compared with participants without headache, headache in general and nonmigraine headache were not associated with total, ischemic, or hemorrhagic stroke.
Conclusions: In these prospective data, migraine was not associated with total, ischemic, or hemorrhagic stroke. In subgroup analyses, we found increased risks of total and ischemic stroke for migraineurs with aura. The absolute risk increase was, however, low, with 3.8 additional cases per year per 10,000 women.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 22 issue to find the title link for this article.
Supported by NIH (CA-47988, HL-43851), Bethesda, MD.
Presented in part at the 56th annual meeting of the American Academy of Neurology, San Francisco, CA.
Received September 16, 2004. Accepted in final form November 28, 2004.
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