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From the Department of Epidemiology (Drs. Stang, Rose, and Ephross, and A.P. Carson), University of North Carolina at Chapel Hill, Chapel Hill, NC; College of Health Sciences (Dr. Stang), West Chester University, West Chester, PA; Safety Evaluation and Epidemiology (Dr. Mo), Pfizer, Inc., New York, NY; GlaxoSmithKline Inc. (Dr. Ephross), Research Triangle Park, NC; Division of Epidemiology (Dr. Shahar), University of Minnesota, Minneapolis, MN; and Department of Epidemiology (Dr. Szklo), Johns Hopkins University, Baltimore, MD.
Address correspondence and reprint requests to Dr. Kathryn M. Rose, Cardiovascular Disease Program, Department of Epidemiology, University of North Carolina at Chapel Hill, Bank of America Center, Suite 306, 137 East Franklin Street, Chapel Hill, NC 27514; e-mail: kathryn_rose{at}unc.edu
Objective: To evaluate the occurrence of stroke/TIA symptoms and ischemic stroke events among those with a lifetime history of migraine or other headaches with some migraine features in a biracial cohort of older adults.
Methods: Participants were 12,750 African-American and white men and women from the Atherosclerosis Risk in Communities Study (1993 to 1995). The participants were queried about their lifetime headache history and characterized using modified International Headache Society diagnostic criteria. Stroke/TIA symptoms were classified using a computerized diagnostic algorithm, and ischemic stroke events were identified and validated using medical records. Multivariate logistic regression was used to assess the relationship between headache types and stroke/TIA symptoms and ischemic stroke events.
Results: Migraine with aura was strongly associated with stroke symptoms (odds ratio [OR] 5.46, 95% CI: 3.64 to 8.18), TIA symptoms (OR 4.28, 95% CI: 3.02 to 6.08), and verified ischemic stroke events (OR 2.81, 95% CI: 1.60 to 4.92). Similarly, other headaches with aura were significantly associated with stroke symptoms (OR 3.68, 95% CI: 2.26 to 5.99) and TIA symptoms (OR 4.53, 95% CI: 3.08 to 6.67). In contrast, the associations for migraine without aura and other headaches without aura were not as consistent or robust.
Conclusions: Migraines and other headaches, particularly those accompanied by aura, were associated with an increased occurrence of stroke/TIA symptoms and ischemic stroke events.
Editorial, see page 1496
Supported by NHLBI contracts N01-HC-55015, N01-HC-55016, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 and by NIH, NHLBI NRSA grant 5T32HL07055 as well as a grant by GlaxoSmithKline.
Dr. Rose was a paid consultant for GlaxoSmithKline in 2001. Dr. Stang is a paid consultant for GlaxoSmithKline (honoraria in excess of $10,000), Bristol-Myers Squibb, Pfizer, MedImmune, AstraZeneca, Allergan, Procter and Gamble, and Schering-Plough. Dr. Mo is employed by Pfizer. Dr. Ephross is employed by GlaxoSmithKline and receives stock options.
Received October 7, 2004. Accepted in final form December 29, 2004.
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