title: Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults.
abstract: Although sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS).
  
  
  
  To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.
  
  
  
  A prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine.
  
  
  
  Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS.
  
  
  
  Of the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P < .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95% CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95% CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95% CI, 1.22-2.71). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P > .99).
  
  
  
  In patients with IS aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with CEAD. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms.
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
authors.forename: Valeria
authors.initials: V
authors.lastname: De Giuli
authors.affiliation: Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italia.
authors.forename: Mario
authors.initials: M
authors.lastname: Grassi
authors.affiliation: Centro Trombosi, Istituto di Ricerca e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano-Milano, Italia.
authors.forename: Corrado
authors.initials: C
authors.lastname: Lodigiani
authors.affiliation: Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università "La Sapienza," Roma, Italia.
authors.forename: Rosalba
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authors.affiliation: Unità di Neurologia, Arcispedale Santa Maria Nuova-Istituto di Ricerca e Cura a Carattere Scientifico, Reggio Emilia, Italia.
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authors.affiliation: Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italia.
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authors.affiliation: Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile "S. Agostino Estense," Azienda Unità Sanitaria Locale, Modena, Italia.
authors.forename: Andrea
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authors.affiliation: Unità di Neurologia, Ospedale di Circolo, Università dell'Insubria, Varese, Italia.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: DeLodovici
authors.affiliation: Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italia.
authors.forename: Maurizio
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authors.initials: RS
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authors.affiliation: Unità Operativa Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, Verona, Italia.
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authors.forename: Maria
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authors.affiliation: Stroke Center, Dipartimento di Neurologia, Ospedale Sacro Cuore Negrar, Verona, Italia.
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authors.affiliation: Neurologia d'Urgenza e Stroke Unit, Istituto di Ricerca e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano-Milano, Italia.
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authors.initials: DM
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authors.affiliation: Unità Operativa Complessa Neurologia, AUSL Romagna, Ravenna, Italia.
authors.forename: Enrico Maria
authors.initials: EM
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authors.affiliation: Unità Operativa Recupero e Rieducazione Funzionale, Istituto di Ricerca e Cura a Carattere Scientifico Fondazione Don Gnocchi, Rovato, Italia.
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authors.affiliation: Unità di Neurologia, Ospedale S. Andrea, La Spezia, Italia.
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authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
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authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
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authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
authors.forename: Filomena
authors.initials: F
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authors.forename: Alessia
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authors.forename: Paola
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authors.lastname: Ferrazzi
authors.affiliation: Unità Operativa Neurologia, Istituti Ospitalieri, Cremona, Italia.
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authors.lastname: Piras
authors.affiliation: Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italia.
authors.forename: Davide
authors.initials: D
authors.lastname: Massucco
authors.affiliation: Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italia.
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authors.affiliation: Laboratorio di Epidemiologia Molecolare e Nutrizionale, Dipartimento di Epidemiologia e Prevenzione, Istituto di Ricerca e Cura a Carattere Scientifico Istituto Neurologico Mediterraneo, Neuromed, Pozzilli, Italia.
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authors.lastname: Iacoviello
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
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mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002545:Brain Ischemia / Q000453:epidemiology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000453:epidemiology*; D020326:Migraine without Aura / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D055815:Young Adult