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Pregnancy-Associated Migraines Linked to Stroke

Peripartum migraines were strongly associated with incidence of ischemic stroke.

Migraine headaches occur in as many as 25% of women of reproductive age. In a study aimed at determining the prevalence of peripartum migraine and its association with other medical conditions during pregnancy, investigators evaluated diagnoses in a nationwide sample of pregnancy-related discharges from U.S. hospitals from 2000 to 2003.

Among more than 18 million discharges, almost 34,000 diagnostic codes contained references to migraines (185/100,000 deliveries). In analyses that excluded preeclampsia, migraine and ischemic stroke were strongly associated (odds ratio, 30.7); migraine was also associated significantly with myocardial infarction, heart disease, and thromboembolic events. Migraine incidence rose with maternal age: Women who were 40 or older were 2.4 times more likely to experience migraines than women who were younger than 20. Women with peripartum migraine, however, were also more likely to have other vascular risk factors, such as diabetes, nongestational hypertension, and smoking. As for pregnancy-related complications, women who had preeclampsia were more than twice as likely to have peripartum migraines as women who did not have preeclampsia.

Comment: At less than 0.2%, the low rate of peripartum hospital discharges coded for migraines suggests that the condition was not included in the discharge codes of many women who experienced migraines during pregnancy. Moreover, several confounding variables (e.g., preeclampsia and many nonpregnancy-related risk factors) emerged. However, despite this study’s limitations, the results echo previous findings that link certain types of migraines to stroke incidence in nonpregnant women (JW Womens Health Oct 25 2007). Clinicians who provide prenatal care for women with migraines should be aware that such women — especially those who are older than 40 or who have other vascular risk factors — are at excess risk for peripartum ischemic stroke.

— Wendy S. Biggs, MD

Published in Journal Watch Women's Health April 2, 2009

Citation(s):

Bushnell CD et al. Migraines during pregnancy linked to stroke and vascular diseases: US population based case-control study. BMJ 2009 Mar 10; 338:b664. (http://dx.doi.org/10.1136/bmj.b664)

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