title: Ischemic stroke subtypes and migraine with visual aura in the ARIC study.
abstract: OBJECTIVE
  To investigate the association among migraine, ischemic stroke, and stroke subtypes in the Atherosclerosis Risk in Communities (ARIC) study.
  
  
  METHODS
  In this ongoing, prospective, longitudinal community-based cohort study, participants were given an interview ascertaining migraine history in 1993-1995, and were followed for all vascular events, including stroke. All stroke events over the subsequent 20 years were adjudicated and classified into stroke subtypes by standard definitions. Cox proportional hazards models adjusted for stroke risk factors were used to study the relationship between migraine and ischemic stroke, overall, as well as stroke subtypes (cardioembolic, lacunar, or thrombotic).
  
  
  RESULTS
  We identified 1,622 migraineurs among 12,758 participants. Mean age of the study population at the 3rd clinical visit was 59 years. When compared to nonheadache participants, there was a significant association between migraine with visual aura and ischemic stroke (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.2-2.6, p = 0.008). Migraine without visual aura was not significantly associated with ischemic stroke (HR 1.2, CI 1.0-1.8, p = 0.28) when compared to nonheadache participants. Among the 3 subtypes of ischemic stroke evaluated, migraine with visual aura was significantly associated only with cardioembolic stroke (HR 3.7, 95% CI 1.6-8.7, p = 0.003).
  
  
  CONCLUSIONS
  In participants with migraine with visual aura in late middle age, increased risk of cardioembolic stroke was observed. Migraine with visual aura was linked to increased stroke risk, while migraine without visual aura was not, over the period of 20 years. These results are specific to older migraineurs.
authors.affiliation: From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: X Michelle
authors.initials: XM
authors.lastname: Androulakis
authors.affiliation: From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Nishanth
authors.initials: N
authors.lastname: Kodumuri
authors.affiliation: From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Giamberardino
authors.affiliation: From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.affiliation: From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.affiliation: From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Eunsil
authors.initials: E
authors.lastname: Yim
authors.affiliation: From the Department of Neurology (X.M.A., N.K., L.D.G., S.S.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (W.D.R., E.Y.), Gillings School of Public Health, University of North Carolina, Chapel Hill; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD. Souvik.Sen@uscmed.sc.edu.
authors.forename: Souvik
authors.initials: S
authors.lastname: Sen
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology*; D004827:Epilepsy / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*