title: Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study.
abstract: OBJECTIVE
  To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate.
  
  
  METHODS
  Prospective hospital registry study.
  
  
  METHODS
  Massachusetts General Hospital and two satellite campuses between January 2007 and August 2014.
  
  
  METHODS
  124 558 surgical patients (mean age 52.6 years; 54.5% women).
  
  
  METHODS
  The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura. The secondary outcome was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location.
  
  
  RESULTS
  10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.6%) perioperative ischemic strokes occurred within 30 days of surgery. Patients with migraine were at increased risk of perioperative ischemic stroke (adjusted odds ratio 1.75, 95% confidence interval 1.39 to 2.21) compared with patients without migraine. The risk was higher in patients with migraine with aura (adjusted odds ratio 2.61, 1.59 to 4.29) than in those with migraine without aura (1.62, 1.26 to 2.09). The predicted absolute risk is 2.4 (2.1 to 2.8) perioperative ischemic strokes for every 1000 surgical patients. This increases to 4.3 (3.2 to 5.3) for every 1000 patients with any migraine diagnosis, 3.9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41).
  
  
  CONCLUSIONS
  Surgical patients with a history of migraine are at increased risk of perioperative ischemic stroke and have an increased 30 day hospital readmission rate. Migraine should be considered in the risk assessment for perioperative ischemic stroke.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Fanny P
authors.initials: FP
authors.lastname: Timm
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Houle
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Grabitz
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.|Department of Anesthesiology, University of Copenhagen, Herlev Hospital, Copenhagen, Denmark.
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Lihn
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.|Department of Anesthesiology, University of Copenhagen, Herlev Hospital, Copenhagen, Denmark.
authors.forename: Janne B
authors.initials: JB
authors.lastname: Stokholm
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Katharina
authors.initials: K
authors.lastname: Eikermann-Haerter
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Ala
authors.initials: A
authors.lastname: Nozari
authors.affiliation: Institute of Public Health, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA meikermann@partners.org.
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
mesh_terms: D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications*; D020325:Migraine with Aura / Q000150:complications*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*