Women With Migraine Had Higher Progression of 10-year Stroke Risk Than Those Without Migraine: Findings From a Nested Case-Control Study

Introduction: There was limited understanding of the association between migraine status and longitudinal changes in stroke risk.

Hypothesis: We hypothesized that migraine patients would have higher growth in 10-year stroke risk than those without migraine during a 1-year follow-up period in Hong Kong Chinese women.

Methods: A nested case-control study was conducted using data from the Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK). The MECH-HK initially enrolled 4,221 Hong Kong Chinese women aged 30-74 years between 2019 and 2021 and followed up with 3,435 participants in the second-round survey until September 2023. Diagnosis of migraine was confirmed according to the ICHD-3 criteria. Stroke risk was calculated using the 10-year China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) stroke risk model. The change in China-PAR stroke risk between the baseline and second-round survey was then computed. Cases were identified as individuals with the top 20% high growth in China-PAR stroke risk. The age-matched controls (±2 years) were randomly selected from the cohort at a 1:1 ratio. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable conditional logistic regression models. Subgroup analyses were performed based on participants' baseline age (<65 years or ≥65 years) and the presence of migraine aura (migraine with or without aura).

Results: A total of 589 cases (aged 60.70 ± 4.31 years) and 589 controls (aged 60.57±6.05 years) were identified (p >0.05). The baseline 10-year China-PAR stroke risk was 2.80%±1.73% and 2.97%±2.01% in the cases and controls, respectively (p >0.05). A total of 48 (8.1%) and 15 (2.5%) women with migraine in the cases group and controls group were identified (p<0.01). During the 1.13-year follow-up period (Interquartile range: 1.07-1.22), migraine was associated with a 3.39-fold increase in the odds of being high growth in China-PAR stroke risk after adjustment for age, education level, drinking, and previous use of oral contraceptive (95% CI: 1.91-6.38, p<0.01). In subgroup analyses, the association was only found in women aged 65 years and older (adjusted OR: 4.12, 95% CI: 2.02-9.34, p<0.01). In addition, a stronger association was observed in women with migraine with aura (adjusted OR: 6.97, 95% CI: 2.33-30.01, p<0.01, migraine with aura vs. non-migraine) than those without aura (adjusted OR: 2.52, 95% CI: 1.29-5.21, p<0.01, migraine without aura vs. non-migraine).

Conclusion: Migraine was associated with higher growth of 10-year stroke risk in a sample of Hong Kong Chinese women, typically in older women and the women with migraine with aura.