title: Role of anticardiolipin antibodies in young persons with migraine and transient focal neurologic events: a prospective study.
abstract: Anticardiolipin antibodies (aCL) are a risk factor for cerebral ischemia. In migraine, the association is controversial, with widely varying results in different small series. The controversy in part may be due to the inherent difficulty in distinguishing the transient focal neurologic events (TFNE) of migraine from TIA. To assess the frequency of aCL in migraine, we prospectively evaluated consecutive adults under 60 years of age with migraine without aura and with recent TFNE (<24-hour duration) clinically suggestive of either migraine with aura or TIA. We concomitantly enrolled persons with no CNS disease. Each person was interviewed and had blood drawn for solid-phase ELISA with IgG and IgM aCL isotyping. Neuroradiologic studies were reviewed. Patients with TFNE were followed every 6 months for the duration of the 3-year study. The frequency of aCL positivity (IgG >20, IgG >40, IgM >7.5) for the 645 patients with TFNE (8.8, 3.1, 4.2%), the 518 persons in the TFNE subgroup with migraine with aura (8.9, 3.3, 4.1%), the 497 persons with migraine without aura (7.0, 2.0, 3.6%), and the 366 control subjects (9.3, 3.6, 3.9%) did not differ significantly between groups. In TFNE patients with elevated aCL titer, the association was positive with diabetes mellitus, TFNE duration <15 minutes, and diplopia and was negative with hemiparesis, tinnitus, and family history of stroke. Findings on imaging consistent with cerebral ischemia were more frequent in aCL-positive persons. The short-term risk of stroke was uniformly low. In young persons, aCL is not associated with migraine or with TFNE, although diabetes mellitus, negative family history of stroke, and brief duration of symptoms (including diplopia) may predict immunoreactivity. Imaging studies suggest an ischemic etiology of TFNE in this cohort.
authors.affiliation: Neurology Center for Stroke Research, Henry Ford Hospital and Health Sciences Center, Case Western Reserve University, Detroit, MI, USA.
authors.forename: G E
authors.initials: GE
authors.lastname: Tietjen
authors.forename: M
authors.initials: M
authors.lastname: Day
authors.forename: L
authors.initials: L
authors.lastname: Norris
authors.forename: S
authors.initials: S
authors.lastname: Aurora
authors.forename: A
authors.initials: A
authors.lastname: Halvorsen
authors.forename: L R
authors.initials: LR
authors.lastname: Schultz
authors.forename: S R
authors.initials: SR
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000276:immunology*; D016022:Case-Control Studies; D003710:Demography; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000276:immunology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000276:immunology*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D017153:Antibodies, Anticardiolipin