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The migraine with visual aura appears to increase the risk of incident atrial fibrillation (AF), a link that could increase the risk of subsequent strokes (CSIs) in this patient population, according to new research.
Investigators found that migraine patients with aura were 30% more likely to develop AF compared to those who had no headaches. they were 40% more likely to develop AF than those who suffered from migraine without aura.
"Our research suggests that atrial fibrillation may play a role in stroke in migraine patients with visual aura." It is important to note that migraine patients with aura may be at higher risk of atrial fibrillation due to nervous system problems. Autonomous, Further research is needed to determine if atrial fibrillation should be sought in visually impaired migraine sufferers, "said lead researcher Souvik Sen, MD, MPH, professor and chair of neurology at University of South Carolina. School of Medicine in Columbia, South Carolina, said in a statement.
The study was published online on November 14 in Neurology.
Migraine and stroke
Previous research has shown that migraine with aura increases the risk of stroke or transient ischemic attack. Previously, a team of investigators had discovered an independent association between migraines with visual aura and ischemic stroke, findings supported by a recent meta-analysis.
AF is a common cause of cardioembolic stroke. Scientists have yet to determine whether the association between migraine and visual aura and cardioembolic stroke can be explained by a higher rate of FA. In the end, if migraine with aura is associated with AF, the authors write that "atrial fibrillation can lead to thromboembolism in the cerebral blood vessels leading to ischemic accidents".
To answer this question, Sen and his colleagues used data from the community atherosclerosis risk cohort (ARIC). This study was launched in 1987 and involved 15,792 participants aged 45 to 64 years.
Follow-up visits took place regularly over the following decades. As part of the ARIC trial, hospital medical records were acquired and vascular risk factors of the patients were assessed. Each year, participants were contacted to determine the onset of any adverse events, including stroke and AF.
ARIC participants responded to a questionnaire on headaches during one of their visits; Modified ICHD-37 diagnostic criteria were used to distinguish migraines with or without visual aura. FA diagnoses were established based on electrocardiographic results, hospital discharge codes, and death certificates. The diagnosis of stroke is the product of both a computer diagnosis and the examination of the medical record of the doctor; the differences were evaluated by a medical examiner.
The investigators analyzed the ARIC data up to the end of 2013 with 11,939 individuals (mean age 60 ± 5.7 years, 56% female) meeting the relevant inclusion criteria; 1516 of them reported a migraine.
During the two-year follow-up period, an accidental AF occurred in 232 migraine sufferers (15.3%) and 1623 in 9,405 people with headaches (17.3%).
Using patients without a headache as a reference group, those who suffer from migraine (risk ratio [HR]0.82; 95% confidence interval [CI]0.72 – 0.94) and migraine without visual aura (HR, 0.74, 95% CI, 0.62 – 0.87) had a significantly lower risk of incident FA than their counterparts with migraine with aura. .
Interestingly, the analysis also found that of the 167 patients who had cardioembolic stroke, the majority (87%, n = 14) of AF cases preceded the stroke.
Among the first American reports
The researchers note that these findings are among the first to indicate an association between migraine and atrial fibrillation in the United States. They point out that the study has strong clinical implications and could eventually lead to a better understanding of the role of AF in the migraine-stroke link.
Although the analysis provides a better understanding of the mechanisms underlying stroke, investigators recognize the need for follow-up work.
"Among the various pathophysiologic mechanisms postulated for the association between migraine with visual aura and incident atrial fibrillation, autonomic dysfunction may play a key role." Further research is needed to determine whether visually impaired migraine sufferers need to do so. the subject of screening for atrial fibrillation, "Sen said. Medscape Medical News.
"Once atrial fibrillation is detected, the clinician may consider using risk scores such as CHADS2-VASc to determine the risk of stroke and place the patient on prophylaxis with aspirin. or oral anticoagulants to reduce the risk of stroke, "he added.
Commenting on the results for Medscape Medical NewsAshfaq Shuaib, MD, professor of medicine and director of the Stroke Program at the University of Alberta in Edmonton, Canada, said the results drew their strength from a data set revealing the nature of the participants' headaches.
"Some other data sets only asked if participants had a headache, which is not really helpful, because the headache has more than a hundred different causes," Shuaib said. .
"However, it would also have been good if they had shown that the rate of atrial fibrillation was higher in individual patients who had a stroke and a migraine with aura," Shuaib added.
The study was funded by the National Heart, the Lung and Blood Institute, and the American Heart Association. Sen and Shuaib did not reveal any relevant financial relationship.
Neurology. Posted online November 14, 2018. Summary
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