J Stroke.
2019 Sep;21(3):324-331. 10.5853/jos.2019.00332.
History of Migraine and Volume of Brain Infarcts: The Italian Project on Stroke at Young Age (IPSYS)
- Affiliations
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- 1Department of Clinical and Experimental Sciences, Neurological Clinic, University of Brescia, Brescia, Italy. alessandro.pezzini@unibs.it
- 2Section of Neuroradiology, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- 3Medical Statistics and Genomics Unit, Department of Nervous System and Behavioral Sciences, University of Pavia, Italy.
- 4Neurology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
- 5IRCCS Neurological Sciences Institute, Neurology Unit and Stroke City Network, Ospedale Maggiore, Bologna, Italy.
- 6Thrombosis Center, IRCCS Humanitas Research Hospital, Milano, Italy.
- 7Emergency Neurology and Stroke Unit, IRCCS Humanitas Research Hospital, Milano, Italy.
- 8Stroke Unit, IRCCS Institute “C. Mondinoâ€, Pavia, Italy.
- 9Emergency Neurology, IRCCS Institute “C. Mondinoâ€, Pavia, Italy.
- 10Stroke Unit, “Sant’Andrea†Hospital, University of Rome “La Sapienzaâ€, Roma, Italy.
- 11Neurology Unit, Ospedale di Circolo, Varese, Italy.
- 12Neurology Unit, University Hospital “Borgo Trentoâ€, Verona, Italy.
- 13Neurology Unit, “Valduce†Hospital, Como, Italy.
- 14Neurology Unit, University Hospital, Pisa, Italy.
- 15Neurology Unit, Ospedale S. Andrea, La Spezia, Italy.
- 16Neurology Unit, “Galliera†Hospital, Genova, Italy.
- 17Neurology Unit, ASST Lariana and “San Paolo†Hospital, ASST “Santi Paolo e Carloâ€, Milano, Italy.
- 18Neurology Unit, University Hospital “San Giovanni di Dio e Ruggu d’Aragonaâ€, Salerno, Italy.
- 19Neurology Unit, Stroke Unit, Azienda Socio-Sanitaria Territoriale (ASST) Vimercate, Vimercate, Italy.
- 20Stroke Unit, Vascular Neurology, “Spedali Civiliâ€, Brescia, Italy.
- 21Department of Biomedical, Experimental and Clinical Sciences, Neuroradiology Unit, University Hospital “Careggiâ€, University of Firenze, Firenze, Italy.
- KMID: 2464649
- DOI: http://doi.org/10.5853/jos.2019.00332
Abstract
- BACKGROUND AND PURPOSE
Migraine has been shown to increase cerebral excitability, promote rapid infarct expansion into tissue with perfusion deficits, and result in larger infarcts in animal models of focal cerebral ischemia. Whether these effects occur in humans has never been properly investigated.
METHODS
In a series of consecutive patients with acute ischemic stroke, enrolled in the setting of the Italian Project on Stroke at Young Age, we assessed acute as well as chronic infarct volumes by volumetric magnetic resonance imaging, and compared these among different subgroups identified by migraine status.
RESULTS
A cohort of 591 patients (male, 53.8%; mean age, 37.5±6.4 years) qualified for the analysis. Migraineurs had larger acute infarcts than non-migraineurs (median, 5.9 cm³ [interquartile range (IQR), 1.4 to 15.5] vs. 2.6 cm³ [IQR, 0.8 to 10.1], P<0.001), and the largest volumes were observed in patients with migraine with aura (median, 9.0 cm³ [IQR, 3.4 to 16.6]). In a linear regression model, migraine was an independent predictor of increased log (acute infarct volumes) (median ratio [MR], 1.64; 95% confidence interval [CI], 1.22 to 2.20), an effect that was more prominent for migraine with aura (MR, 2.92; 95% CI, 1.88 to 4.54).
CONCLUSIONS
These findings reinforce the experimental observation of larger acute cerebral infarcts in migraineurs, extend animal data to human disease, and support the hypothesis of increased vulnerability to ischemic brain injury in people suffering migraine.
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