Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults

Valeria De Giuli; Mario Grassi; Corrado Lodigiani; Rosalba Patella; Marialuisa Zedde; Carlo Gandolfo; Andrea Zini; Maria Luisa DeLodovici; Maurizio Paciaroni; Massimo Del Sette; Cristiano Azzini; Antonella Toriello; Rossella Musolino; Rocco Salvatore Calabrò; Paolo Bovi; Maria Sessa; Alessandro Adami; Giorgio Silvestrelli; Anna Cavallini; Simona Marcheselli; Domenico Marco Bonifati; Nicoletta Checcarelli; Lucia Tancredi; Alberto Chiti; Enrico Maria Lotti; Elisabetta Del Zotto; Giampaolo Tomelleri; Alessandra Spalloni; Elisa Giorli; Paolo Costa; Loris Poli; Andrea Morotti; Filomena Caria; Alessia Lanari; Giacomo Giacalone; Paola Ferrazzi; Alessia Giossi; Valeria Piras; Davide Massucco; Cataldo D'Amore; Filomena Di Lisi; Ilaria Casetta; Laura Cucurachi; Masina Cotroneo; Alessandro De Vito; Elisa Coloberti; Maurizia Rasura; Anna Maria Simone; Giuseppe Micieli; Licia Iacoviello; Italian Project on Stroke in Young Adults Investigators

doi:10.1001/jamaneurol.2016.5704

Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults

Valeria De Giuli, Mario Grassi, Corrado Lodigiani, Rosalba Patella, Marialuisa Zedde, Carlo Gandolfo, Andrea Zini, Maria Luisa DeLodovici, Maurizio Paciaroni, Massimo Del Sette, Cristiano Azzini, Antonella Toriello, Rossella Musolino, Rocco Salvatore Calabrò, Paolo Bovi, Maria Sessa, Alessandro Adami, Giorgio Silvestrelli, Anna Cavallini, Simona MarcheselliDomenico Marco Bonifati, Nicoletta Checcarelli, Lucia Tancredi, Alberto Chiti, Enrico Maria Lotti, Elisabetta Del Zotto, Giampaolo Tomelleri, Alessandra Spalloni, Elisa Giorli, Paolo Costa, Loris Poli, Andrea Morotti, Filomena Caria, Alessia Lanari, Giacomo Giacalone, Paola Ferrazzi, Alessia Giossi, Valeria Piras, Davide Massucco, Cataldo D'Amore, Filomena Di Lisi, Ilaria Casetta, Laura Cucurachi, Masina Cotroneo, Alessandro De Vito, Elisa Coloberti, Maurizia Rasura, Anna Maria Simone, Giuseppe Micieli, Licia Iacoviello, Italian Project on Stroke in Young Adults Investigators

Research output: Contribution to journal › Article › peer-review

Abstract

Importance: 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).

Objective: To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.

Design, Setting, and Participants: 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.

Main Outcomes and Measures: Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS.

Results: 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).

Conclusions and Relevance: 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.

Original language	English
Pages (from-to)	512-518
Number of pages	7
Journal	JAMA Neurology
Volume	74
Issue number	5
DOIs	https://doi.org/10.1001/jamaneurol.2016.5704
Publication status	Published - May 1 2017

Keywords

Adolescent
Adult
Age Factors
Brain Ischemia
Case-Control Studies
Female
Humans
Intracranial Arterial Diseases
Italy
Male
Middle Aged
Migraine with Aura
Migraine without Aura
Prospective Studies
Registries
Sex Factors
Stroke
Young Adult
Journal Article
Multicenter Study

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De Giuli, V., Grassi, M., Lodigiani, C., Patella, R., Zedde, M., Gandolfo, C., Zini, A., DeLodovici, M. L., Paciaroni, M., Del Sette, M., Azzini, C., Toriello, A., Musolino, R., Calabrò, R. S., Bovi, P., Sessa, M., Adami, A., Silvestrelli, G., Cavallini, A., ... Italian Project on Stroke in Young Adults Investigators (2017). Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults. JAMA Neurology, 74(5), 512-518. https://doi.org/10.1001/jamaneurol.2016.5704

Association Between Migraine and Cervical Artery Dissection : The Italian Project on Stroke in Young Adults. / De Giuli, Valeria; Grassi, Mario; Lodigiani, Corrado; Patella, Rosalba; Zedde, Marialuisa; Gandolfo, Carlo; Zini, Andrea; DeLodovici, Maria Luisa; Paciaroni, Maurizio; Del Sette, Massimo; Azzini, Cristiano; Toriello, Antonella; Musolino, Rossella; Calabrò, Rocco Salvatore; Bovi, Paolo; Sessa, Maria; Adami, Alessandro; Silvestrelli, Giorgio; Cavallini, Anna; Marcheselli, Simona; Bonifati, Domenico Marco; Checcarelli, Nicoletta; Tancredi, Lucia; Chiti, Alberto; Lotti, Enrico Maria; Del Zotto, Elisabetta; Tomelleri, Giampaolo; Spalloni, Alessandra; Giorli, Elisa; Costa, Paolo; Poli, Loris; Morotti, Andrea; Caria, Filomena; Lanari, Alessia; Giacalone, Giacomo; Ferrazzi, Paola; Giossi, Alessia; Piras, Valeria; Massucco, Davide; D'Amore, Cataldo; Di Lisi, Filomena; Casetta, Ilaria; Cucurachi, Laura; Cotroneo, Masina; De Vito, Alessandro; Coloberti, Elisa; Rasura, Maurizia; Simone, Anna Maria ; Micieli, Giuseppe ; Iacoviello, Licia; Italian Project on Stroke in Young Adults Investigators.

In: JAMA Neurology, Vol. 74, No. 5, 01.05.2017, p. 512-518.

Research output: Contribution to journal › Article › peer-review

De Giuli, V, Grassi, M, Lodigiani, C, Patella, R, Zedde, M, Gandolfo, C, Zini, A, DeLodovici, ML, Paciaroni, M, Del Sette, M, Azzini, C, Toriello, A, Musolino, R, Calabrò, RS, Bovi, P, Sessa, M, Adami, A, Silvestrelli, G, Cavallini, A, Marcheselli, S, Bonifati, DM, Checcarelli, N, Tancredi, L, Chiti, A, Lotti, EM, Del Zotto, E, Tomelleri, G, Spalloni, A, Giorli, E, Costa, P, Poli, L, Morotti, A, Caria, F, Lanari, A, Giacalone, G, Ferrazzi, P, Giossi, A, Piras, V, Massucco, D, D'Amore, C, Di Lisi, F, Casetta, I, Cucurachi, L, Cotroneo, M, De Vito, A, Coloberti, E, Rasura, M, Simone, AM , Micieli, G , Iacoviello, L & Italian Project on Stroke in Young Adults Investigators 2017, 'Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults', JAMA Neurology, vol. 74, no. 5, pp. 512-518. https://doi.org/10.1001/jamaneurol.2016.5704

De Giuli, Valeria ; Grassi, Mario ; Lodigiani, Corrado ; Patella, Rosalba ; Zedde, Marialuisa ; Gandolfo, Carlo ; Zini, Andrea ; DeLodovici, Maria Luisa ; Paciaroni, Maurizio ; Del Sette, Massimo ; Azzini, Cristiano ; Toriello, Antonella ; Musolino, Rossella ; Calabrò, Rocco Salvatore ; Bovi, Paolo ; Sessa, Maria ; Adami, Alessandro ; Silvestrelli, Giorgio ; Cavallini, Anna ; Marcheselli, Simona ; Bonifati, Domenico Marco ; Checcarelli, Nicoletta ; Tancredi, Lucia ; Chiti, Alberto ; Lotti, Enrico Maria ; Del Zotto, Elisabetta ; Tomelleri, Giampaolo ; Spalloni, Alessandra ; Giorli, Elisa ; Costa, Paolo ; Poli, Loris ; Morotti, Andrea ; Caria, Filomena ; Lanari, Alessia ; Giacalone, Giacomo ; Ferrazzi, Paola ; Giossi, Alessia ; Piras, Valeria ; Massucco, Davide ; D'Amore, Cataldo ; Di Lisi, Filomena ; Casetta, Ilaria ; Cucurachi, Laura ; Cotroneo, Masina ; De Vito, Alessandro ; Coloberti, Elisa ; Rasura, Maurizia ; Simone, Anna Maria ; Micieli, Giuseppe ; Iacoviello, Licia ; Italian Project on Stroke in Young Adults Investigators. / Association Between Migraine and Cervical Artery Dissection : The Italian Project on Stroke in Young Adults. In: JAMA Neurology. 2017 ; Vol. 74, No. 5. pp. 512-518.

@article{b30bc757e2e441b08c166be72a33c554,

title = "Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults",

abstract = "Importance: 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).Objective: To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.Design, Setting, and Participants: 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.Main Outcomes and Measures: Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS.Results: 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).Conclusions and Relevance: 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.",

keywords = "Adolescent, Adult, Age Factors, Brain Ischemia, Case-Control Studies, Female, Humans, Intracranial Arterial Diseases, Italy, Male, Middle Aged, Migraine with Aura, Migraine without Aura, Prospective Studies, Registries, Sex Factors, Stroke, Young Adult, Journal Article, Multicenter Study",

author = "{De Giuli}, Valeria and Mario Grassi and Corrado Lodigiani and Rosalba Patella and Marialuisa Zedde and Carlo Gandolfo and Andrea Zini and DeLodovici, {Maria Luisa} and Maurizio Paciaroni and {Del Sette}, Massimo and Cristiano Azzini and Antonella Toriello and Rossella Musolino and Calabr{\`o}, {Rocco Salvatore} and Paolo Bovi and Maria Sessa and Alessandro Adami and Giorgio Silvestrelli and Anna Cavallini and Simona Marcheselli and Bonifati, {Domenico Marco} and Nicoletta Checcarelli and Lucia Tancredi and Alberto Chiti and Lotti, {Enrico Maria} and {Del Zotto}, Elisabetta and Giampaolo Tomelleri and Alessandra Spalloni and Elisa Giorli and Paolo Costa and Loris Poli and Andrea Morotti and Filomena Caria and Alessia Lanari and Giacomo Giacalone and Paola Ferrazzi and Alessia Giossi and Valeria Piras and Davide Massucco and Cataldo D'Amore and {Di Lisi}, Filomena and Ilaria Casetta and Laura Cucurachi and Masina Cotroneo and {De Vito}, Alessandro and Elisa Coloberti and Maurizia Rasura and Simone, {Anna Maria} and Giuseppe Micieli and Licia Iacoviello and {Italian Project on Stroke in Young Adults Investigators}",

year = "2017",

month = may,

day = "1",

doi = "10.1001/jamaneurol.2016.5704",

language = "English",

volume = "74",

pages = "512--518",

journal = "JAMA Neurology",

issn = "2168-6149",

publisher = "American Medical Association",

number = "5",

}

TY - JOUR

T1 - Association Between Migraine and Cervical Artery Dissection

T2 - The Italian Project on Stroke in Young Adults

AU - De Giuli, Valeria

AU - Grassi, Mario

AU - Lodigiani, Corrado

AU - Patella, Rosalba

AU - Zedde, Marialuisa

AU - Gandolfo, Carlo

AU - Zini, Andrea

AU - DeLodovici, Maria Luisa

AU - Paciaroni, Maurizio

AU - Del Sette, Massimo

AU - Azzini, Cristiano

AU - Toriello, Antonella

AU - Musolino, Rossella

AU - Calabrò, Rocco Salvatore

AU - Bovi, Paolo

AU - Sessa, Maria

AU - Adami, Alessandro

AU - Silvestrelli, Giorgio

AU - Cavallini, Anna

AU - Marcheselli, Simona

AU - Bonifati, Domenico Marco

AU - Checcarelli, Nicoletta

AU - Tancredi, Lucia

AU - Chiti, Alberto

AU - Lotti, Enrico Maria

AU - Del Zotto, Elisabetta

AU - Tomelleri, Giampaolo

AU - Spalloni, Alessandra

AU - Giorli, Elisa

AU - Costa, Paolo

AU - Poli, Loris

AU - Morotti, Andrea

AU - Caria, Filomena

AU - Lanari, Alessia

AU - Giacalone, Giacomo

AU - Ferrazzi, Paola

AU - Giossi, Alessia

AU - Piras, Valeria

AU - Massucco, Davide

AU - D'Amore, Cataldo

AU - Di Lisi, Filomena

AU - Casetta, Ilaria

AU - Cucurachi, Laura

AU - Cotroneo, Masina

AU - De Vito, Alessandro

AU - Coloberti, Elisa

AU - Rasura, Maurizia

AU - Simone, Anna Maria

AU - Micieli, Giuseppe

AU - Iacoviello, Licia

AU - Italian Project on Stroke in Young Adults Investigators

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Importance: 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).Objective: To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.Design, Setting, and Participants: 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.Main Outcomes and Measures: Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS.Results: 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).Conclusions and Relevance: 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.

AB - Importance: 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).Objective: To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.Design, Setting, and Participants: 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.Main Outcomes and Measures: Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS.Results: 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).Conclusions and Relevance: 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.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Brain Ischemia

KW - Case-Control Studies

KW - Female

KW - Humans

KW - Intracranial Arterial Diseases

KW - Italy

KW - Male

KW - Middle Aged

KW - Migraine with Aura

KW - Migraine without Aura

KW - Prospective Studies

KW - Registries

KW - Sex Factors

KW - Stroke

KW - Young Adult

KW - Journal Article

KW - Multicenter Study

U2 - 10.1001/jamaneurol.2016.5704

DO - 10.1001/jamaneurol.2016.5704

M3 - Article

C2 - 28264095

VL - 74

SP - 512

EP - 518

JO - JAMA Neurology

JF - JAMA Neurology

SN - 2168-6149

IS - 5

ER -

Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults

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Keywords

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