Five-Factor Risk Score Helps Predict Ischemic Stroke Risk In People With Migraine With Aura

Researchers have developed a simple tool to help determine the risk of ischemic stroke in adults with migraine with aura.

About a third of migraine sufferers have migraine with aura, which is associated with an increased stroke risk, study co-author Dr. Souvik Sen of the University of South Carolina School of Medicine in Columbia told Reuters Health by email. "There may be utility in surveillance of these patients at higher stroke risk and potential measures to prevent stroke."

The research was presented February 21 at the American Stroke Association International Stroke Conference in Los Angeles.

The Migraine With Aura as a Risk for Ischemic Stroke (MARS) risk score was developed using data from the long-running Atherosclerosis Risk in Communities Cohort (ARIC) study, which has been following a group of adults from four US counties since 1987. A total of 429 ARIC participants (mostly women) with a history of migraine with aura contributed data to the project.

The tool includes five risk factors for stroke, with each factor assigned a number of points proportional to its influence: diabetes (7 points), age greater than 65 years (5 points), heart rate variability (3 points), hypertension (3 points) and female gender (1 point).

Scores were calculated for each individual and participants classified into one of three groups: low-risk (0 to 4 points), intermediate-risk (5 to 10 points) and high-risk (11 to 21 points).

Over an average of 18 years of follow-up, 32 people suffered a stroke, including 3% in the low-risk group, 8% in the intermediate-risk group and 34% in the high-risk group.

The hazard ratio for ischemic stroke in the high-risk vs the low-risk group was 7.35 (P=0.003). Kaplan Meier curves showed significant discrimination of stroke risk among the risk stratification groups (P<0.001), Dr. Sen and colleagues report in their meeting abstract.

"The new risk score will need to be validated in an external dataset with similar information, and once that is completed may be used in the clinical setting," Dr. Sen told Reuters Health.

Commenting on the study in a podcast, Dr. Karen Furie, member of the American Heart Association/American Stroke Association Stroke Council Research Committee, said the research shows that diabetes, high blood pressure, and heart-rate variability all contribute to risk of stroke.

"And it is within an individual's power to help modify, in particular, the risk associated with hypertension, which is a major cause of both ischemic and hemorrhagic stroke. And so this study really reiterates the need for both measuring and treating blood pressure when it's elevated," she said.

"It's also potentially a flag for healthcare providers to scrutinize patients who have been treated for migraine with aura in order to establish whether additional testing, such as an electrocardiogram, may be useful to identify future risk. Doing an electrocardiogram in patients with migraine is not standard practice at the current time but this study indicates that it may be a predictor of stroke risk in the future," said Dr. Furie, who chairs the neurology department at The Warren Alpert Medical School of Brown University in Providence, Rhode Island.

The study was funded by the National Institute on Minority Health and Health Disparities of the National Institutes of Health.

—Megan Brooks

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