1. Women with migraines are at an increased risk of stroke during and after pregnancy compared to those without migraines.
Evidence Rating Level: 2 (Good)
Increased risk of maternal stroke is associated with migraines during the perinatal period, with the belief that hypertension and related disorders mediate this relationship. However, this relationship has not been formally quantified in a research setting. This retrospective cohort study of 3 million live, singleton births between January 2007 and December 2012 sought to determine the degree to which hypertensive disorders impact the association between maternal stroke (ischemic and hemorrhagic) and migraines. A total of 2,866,316 births fell into the no migraine group and 26,440 births fell into the migraine group (≥1 ICD-9 migraine code). Hispanic women were the majority ethnic group in the no migraine group (48.9%) while non-Hispanic whites (41.0%) and Hispanics (34.7%) were the most represented in the migraine group. A total of 843 women experienced strokes, with 58% being ischemic strokes. Women experiencing stroke were more likely to have private insurance, use drugs or alcohol, have diabetes and/or obesity, have a pre-existing mental health condition, and be non-Hispanic. Women with migraines were also more likely to have a hypertensive disorder, including preeclampsia (difference 8.1%, adjusted RR 1.6, 95% CI 1.6 to 1.7), have a stroke during pregnancy or delivery (difference 0.14%, adjusted RR 6.8, 95% CI 4.7 to 9.8), or have a postpartum stroke (difference 0.04%, adjusted RR 2.1, 95% CI 1.2 to 3.7). Effects were noted as twice as strong among models for ischemic stroke compared to hemorrhagic stroke, given the small numbers. Mediation analysis suggested that hypertensive disorders mediated 21% of stroke risk during pregnancy and delivery and 27% of stroke risk postpartum. Overall, this study demonstrates that migraines significantly increase the risk of stroke in women during and after pregnancy, such that the identification of modifiable risk factors is important in prenatal care.
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