Predictors of migraine subtypes in young adults with ischemic stroke: the italian project on stroke in young adults.
OBJECTIVE
the mechanisms underlying the relationship between migraine and ischemic stroke remain uncertain. The aim of the present study was to investigate the predictive value of major cardiovascular risk factors, cardiac interatrial abnormalities, and additional biological markers on migraine subtypes in young adults with ischemic stroke.


METHODS
ischemic stroke patients aged 45 years or younger were consecutively enrolled as part of the Italian Project on Stroke in Young Adults. A comprehensive evaluation was performed including assessment of self-reported migraine and cardiovascular risk factors, interatrial right-to-left shunt, and genotyping to detect factor V Leiden and the G20210A mutation in the prothrombin gene.


RESULTS
nine hundred eighty-one patients (mean age, 36.0 ± 7.6 years; 50.7% women) were included. The risk of migraine with aura increased with decreasing number of cardiovascular risk factors (OR, 0.50; 95% CI, 0.24-0.99 for 2 factors or more), increasing number of thrombophilic variants (OR, 2.21; 95% CI, 1.05-4.68 for carriers of at least 1 of the 2), and the presence of right-to-left shunt (OR, 2.41; 95% CI, 1.37-3.45), as compared to patients without migraine. None of these factors had influence on the risk of migraine without aura.


CONCLUSIONS
in young adults with ischemic stroke, low cardiovascular risk profile, right-to-left shunt, and an underlying procoagulant state are predictors of migraine with aura. The biological effects of these factors should be considered in future studies aimed at investigating the mechanisms linking migraine to brain ischemia.
Dipartimento di Scienze Mediche e Chirurgiche, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25100 Brescia, Italia. ale_pezzini@hotmail.com
Alessandro
A
Pezzini
Mario
M
Grassi
Corrado
C
Lodigiani
Rosalba
R
Patella
Carlo
C
Gandolfo
Federica
F
Casoni
Rossella
R
Musolino
Rocco Salvatore
RS
Calabrò
Paolo
P
Bovi
Alessandro
A
Adami
Maria Luisa
ML
Delodovici
Elisabetta
E
Del Zotto
Lidia Luciana
LL
Rota
Maurizia
M
Rasura
Massimo
M
Del Sette
Alessia
A
Giossi
Irene
I
Volonghi
Andrea
A
Zini
Paolo
P
Cerrato
Paolo
P
Costa
Mauro
M
Magoni
Licia
L
Iacoviello
Alessandro
A
Padovani
D000328:Adult; D002545:Brain Ischemia / Q000453:epidemiology / Q000235:genetics*; D005165:Factor V / Q000235:genetics* / Q000378:metabolism; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000097:blood / Q000453:epidemiology / Q000235:genetics*; D009154:Mutation; D011237:Predictive Value of Tests; D011516:Prothrombin / Q000235:genetics* / Q000378:metabolism; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology / Q000235:genetics*
C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin