Migraine, migraine aura, and cervical artery dissection: a systematic review and meta-analysis.

OBJECTIVE We evaluated the current evidence on the association between migraine, including aura status, and cervical artery dissection. METHODS We performed a systematic review and meta-analysis of studies investigating the association between migraine or migraine subtypes (e.g. migraine with aura) and cervical artery dissection published through October 2010. RESULTS We identified five case-control studies investigating the association between migraine and cervical artery dissection. In pooled analysis, migraine doubled the risk of cervical artery dissection (pooled odds ratio [OR]=2.06, 95% confidence interval [CI] 1.33-3.19). All studies allowed evaluation of migraine aura status. While the effect estimate for migraine without aura (pooled OR=1.94, 95% CI 1.21-3.10) was similar to overall migraine, the association was weaker for migraine with aura (pooled OR= 1.50, 95% CI 0.76-2.96). However, there is no evidence that aura status significantly modifies the association between migraine and cervical artery dissection (meta-regression on aura status p= .58). The risk does not appear to differ between women and men; however, only few studies presented gender-specific data. Heterogeneity among studies was low to moderate. CONCLUSION In this meta-analysis migraine is associated with a two-fold increased risk of cervical artery dissection. This risk does not appear to significantly differ by migraine aura status or gender.