Risk of Stroke in Migraineurs Using Triptans. Associations with Age, Sex, Stroke Severity and Subtype

• Migraineurs (identified by triptan utilization) are at higher risk for stroke.
• The risk is not related to use of triptans as such. Rather the risk seems to be a consequence of the underlying migraine disease.
• In migraineurs strokes are minor and less often associated classical stroke risk factors. Major strokes are uncommon.
• The study points to an etiology of stroke in migraine different from thromboembolism, probably at the microvascular level.We used triptan utilization as an alternative way of identifying migraine. In this study of the entire Danish population aged 25–80 years migraineurs identified in this way were at higher risk for stroke. The increased risk was not related to use of triptans as such: Rather the risk seems to be a consequence of the underlying migraine disease. Characteristically, strokes in migraineurs are minor strokes and less often associated with classical stroke risk factors. Major strokes are uncommon. The study points to an etiology of stroke in migraineurs different from that of atherosclerotic thromboembolism, probably at the microvascular level.

BackgroundIdentifying migraineurs by triptan utilization we studied risk for stroke in migraineurs compared to the general population.MethodsA cohort study including all citizens 25–80 years of age in Denmark 2003–2011 was conducted. All persons prescribed triptans, and all those hospitalized for a first stroke were identified in the Danish Registries. Information on stroke severity/subtype and cardiovascular risk factors was available for stroke patients.FindingsOf the 49,711 patients hospitalized for a first stroke, 1084 were migraineurs using triptans. Adjusting for age, sex, income, and educational level, risk for stroke was higher among migraineurs in respect to all strokes (RR 1.07; CI 1.01–1.14) and ischemic strokes (RR 1.07; CI 1.00–1.14). Risk for hemorrhagic stroke was increased but only in women (RR 1.41; CI 1.11–1.79). Risk was for mild strokes (RR 1.31; CI 1.16–1.48) while risk for severe strokes was lower among migraineurs (RR 0.77; CI 0.65–0.91). Risk was age-related; highest among women 25–45 years (RR ≈ 1.7). Risk was unrelated to numbers of dispensations.InterpretationMigraineurs identified by triptan utilization had higher risk for stroke. Strokes were minor and cardiovascular risk factors were less prevalent pointing to a migraine-specific etiology of stroke different from that of thromboembolism.