Association between ischemic stroke and migraine in elderly Chinese: a case–control study

BACKGROUND Recent observations suggest that migraine and cerebrovascular disease are comorbid conditions. However, the association of migraine with cerebrovascular disease in the population of elderly Chinese has not been established. This prospective case-control study aimed to investigate the prevalence and lesion characteristics of migraine in elderly Chinese patients with acute cerebral infarction (ACI). METHODS A total of 968 ACI patients aged 55-70 years and 1024 sex- and age-matched control subjects were recruited between January, 2003 and July, 2009. Migraine was determined based on the International Headache Society's Classification of Headache Disorders, together with past medical records and admission examination results, following an initial questionnaire screening at the first hospital visit. Prevalence rates of overall migraine, migraine with aura and migraine without aura in both ACI patients and control subjects, the stroke subtypes classified according to the Chinese Ischemic Stroke Subclassification (CISS) system and brain locations of the ischemic lesions in ACI patients were analyzed. RESULTS The overall prevalence rate of migraine was 17.15% (166/968) in patients with ACI but only 3.9% (40/1024) in control subjects (P < 0.01). In both subject groups, over 80% of migraine cases were migraine without aura. In the 166 ACI patients with comorbid migraine, large artery atherosclerosis was the most frequent subtype of ischemic lesion (65.06%), followed by cardiogenic stroke (23.50%), and all other lesion subtypes were each less than 10%. Ischemic infarctions were located predominantly in the anterior circulation in the brain in both ACI patients with and without migraine. CONCLUSIONS The prevalence rate of migraine is significantly higher in ACI patients than non-ACI subjects in the population of elderly Chinese. Migraine without aura is the major form of migraine in both ACI patients and non-ACI subjects. In ACI patients, regardless of migraine, infarction lesions were predominantly located in the anterior cerebral circulation.