Patients who undergo surgery have an increased risk of perioperative ischemic stroke if they have a history of migraine, according to a prospective study published January 10 in the BMJ. Surgical patients with a history of migraine also have an increased 30-day hospital readmission rate, compared with patients without migraine.
“Understanding this risk period offers unique opportunities to study ischemic stroke in migraine and might result in treatment considerations for patients at risk who are not undergoing surgical intervention,” said Matthias Eikermann, MD, PhD, Associate Professor of Anesthesia at Harvard Medical School in Boston, and colleagues. “An individual perioperative risk assessment for perioperative ischemic stroke in patients with migraine undergoing surgery may be crucial.”
Matthias Eikermann, MD, PhD
Dr. Eikermann and colleagues conducted a prospective hospital registry study that encompassed 124,558 patients who underwent surgery at Massachusetts General Hospital and two community hospitals in Massachusetts between January 2007 and August 2014. The researchers determined participants’ history of migraine and migraine aura status using ICD-9 diagnosis codes. The primary outcome was perioperative ischemic stroke within 30 days after surgery. The secondary outcome was hospital readmission within 30 days of discharge.
The mean age of participants was 52.6. Approximately 55% of patients were women. The investigators identified 10,179 (8.2%) patients with migraine, of whom 1,278 (12.6%) had migraine with aura. Compared with participants without migraine, migraineurs were more often female, were younger, and had an overall lower frequency of vascular risk factors.
Among the 124,558 patients who underwent surgery, the investigators observed 771 (0.6%) perioperative ischemic strokes. Of all patients with perioperative ischemic stroke, 89 (11.5%) had migraine. Among migraineurs, 18 (2.3%) had migraine with aura, and 71 (9.2%) had migraine without aura. Patients with migraine had an increased risk for perioperative ischemic stroke, compared with patients without migraine (adjusted odds ratio, 1.75). The risk of ischemic stroke was higher for patients with migraine with aura (adjusted odds ratio, 2.61), but also was apparent for migraine without aura (adjusted odds ratio, 1.62), compared with surgical patients without migraine.
Dr. Eikermann and colleagues predicted that 2.4 ischemic strokes would occur for every 1,000 surgical patients. This risk increased to 4.3 strokes for every 1,000 patients with migraine. Stratified by migraine with aura status, these numbers are 3.9 strokes for migraine without aura and 6.3 strokes for migraine with aura.
A total of 10,088 participants were readmitted to the hospital within 30 days. The 30-day hospital readmission rate was higher for patients with migraine than for those with no migraine (adjusted odds ratio, 1.31). Migraine with aura (adjusted odds ratio, 1.59) and migraine without aura (adjusted odds ratio, 1.27) were associated with a higher risk of 30-day hospital readmission, compared with patients without migraine.
“The use of high-dose vasopressors during surgery, as well a history of a possible right-to-left shunt, may represent modifiable risk factors for perioperative ischemic stroke in patients with migraine with aura,” said Dr. Eikermann. “Early detection of symptoms of stroke through close postoperative monitoring of patients at high risk should be crucial to optimize the value of perioperative care in patients with migraine.”
—Erik Greb
Suggested Reading
Timm FP, Houle TT, Grabitz SD, et al. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ. 2017 Jan 10;356:i6635.