A prospective cohort study in Italy found an association between migraine and spontaneous cervical artery dissection (CEAD) among young to middle-age adults, even after adjusting for traditional vascular risk factors.

Lead researcher Valeria De Giuli, MD, MSCR, of the University of Brescia in Italy, and colleagues published their results online in JAMA Neurology on March 6.

The researchers mentioned that spontaneous CEAD was the most frequent cause of ischemic stroke in young and middle-aged adults.

In this study, known was the Italian Project on Stroke in Young Adults, they enrolled white patients who were 18 to 45 years old and had their first acute stroke and a cerebral infarction. They evaluated 2,485 patients who were admitted to 26 hospitals in Italy from Jan. 1, 2000, through June 30, 2015.

The patients underwent an etiologic workup to investigate extracranial and intracranial vessels and had their personal history of headache assessed during interviews in the acute phase and follow-up evaluations.

The mean age of patients was 36.8 years old, and 46.8 percent were women. Of the patients, 13.4 percent were diagnosed with CEAD ischemic stroke and 86.6 percent had non-CEAD ischemic stroke.

Patients with non-CEAD ischemic stroke were more likely to have diabetes and hypercholesterolemia and smoke cigarettes. In addition, 30.8 percent of patients with CEAD ischemic stroke and 24.4 percent of patients with non-CEAD ischemic stroke had migraine, which was a statistically significant difference. The groups had significant differences in the frequency of migraine without aura, but the frequency of migraine with aura was similar between the groups.

After the researchers adjusted for several variables, they found that migraine with aura was significantly associated with CEAD ischemic stroke, but there was no significant association between migraine with aura and CEAD ischemic stroke. The strength of the association was higher among men and patients who were 39 years old or younger. They also found a significant association between non-CEAD ischemic stroke and diabetes, current smoking and hypercholesterolemia.

The researchers acknowledged the study might have a few limitations, including that the results could be susceptible to hospital selection bias. They also did not assess migraine frequency and severity or the frequency of auras, and they did not have information on the use of migraine-specific medications. In addition, the participants were white, between 18 and 45 years old and had a documented cerebral infarct, so the findings might not be generalizable to other patient populations. Further, the data were observational, so the results could be subject to residual confounding.

“Our data support consideration of a history of migraine as a marker for increased risk of [ischemic stroke] caused by CEAD, as well as a putative susceptibility factor for CEAD, regardless of its clinical features,” the researchers wrote. “This finding emphasizes the need for further analyses to investigate the nature and mechanisms of elevated risk in [migraine sufferers] and to elucidate whether this risk applies to only specific subsets of patients with migraine.”