Document Detail


Stroke and chest pain in young people with migraine.
MedLine Citation:
PMID:  16492229     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cerebrovascular and cardiovascular complications in migraineurs may be part of the migraine process and also consequent to triptan treatment. AIM: To determine the frequency, subtypes and associations of migraine-associated stroke and angina in young people (18-49 years). METHODS: Patients were derived from a tertiary referral migraine and stroke registry. Migraine-associated stroke was classified according to the four groups described by Welch and by the TOAST etiological stroke classification. A clinical description of angina during a migraine attack was required for the diagnosis of cardiac migraine without concomitant triptan or other vasoactive medications. RESULTS: Of the young patients with stroke (349/1316; 26.5%), there were 30 (30/349; 8.6%) who had migraine at the time of stroke when categorized by the Welch classification type II to IV (type II n = 5, type III n = 2, type IV n = 3). Comparison of type I (n = 20) versus types II-IV (n = 10) showed significant difference (P = .03). Topographically the lesions were distributed into the partial anterior circulation (n = 8) and posterior circulation (n = 2) (P = .04). Comparison of anterior and posterior circulation territories of infarction indicated significant difference (n = 26/30 and 4/30; P = .01). The stroke etiological subtypes included cardiogenic (n = 5), atherogenic (n = 15), other (n = 5), and unknown (n = 5), with none diagnosed with small-vessel cerebrovascular disease. Traditional stroke mechanistic entities (cardiac and atherogenic) differed significantly in comparison to the other and unknown categories P = .05. Cardiovascular patients with angina during a migraine attack (n = 9/1040; 0.9%), included IHS subtypes; migraine without aura (n = 4), migraine with aura (n = 4), and complicated migraine (n = 1). One patient required cardiac catheterization on account of significant ECG changes, with documented, reversible vasospasm. CONCLUSION: (i) Migraine-induced stroke remains controversial, with only two probable cases of type Welch III A+B in a large registry. (ii) Cardiac migraine may be a distinct entity requiring careful differentiation from triptan-induced chest pain.
Authors:
Michael Hoffmann
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Headache     Volume:  46     ISSN:  0017-8748     ISO Abbreviation:  Headache     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-22     Completed Date:  2006-09-01     Revised Date:  2009-02-02    
Medline Journal Info:
Nlm Unique ID:  2985091R     Medline TA:  Headache     Country:  United States    
Other Details:
Languages:  eng     Pagination:  208-11     Citation Subset:  IM    
Affiliation:
Department of Urology, University of South Florida, Tampa 33612, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Chest Pain / etiology*
Female
Humans
Male
Middle Aged
Migraine Disorders / complications*
Prospective Studies
Stroke / classification,  etiology*

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