Pregnant women who experience active peripartum migraine are at risk for stroke and other vascular diagnoses, according to a study in the March 10 BMJ.
Cheryl D. Bushnell, MD, MHS, Associate Professor in the Department of Neurology, Wake Forest University Medical Center, Winston-Salem, North Carolina, and colleagues examined a nationwide inpatient sample of 18,345,538 pregnancy-related discharges from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, from 2000 to 2003. Diagnosis of migraine, stroke, or other vascular diseases was the main outcome measure.
Among hospital discharges with a pregnancy code, 33,956 also had a discharge code for migraine (185 per 100,000 deliveries). Women 40 and older were 2.4-fold more likely to be discharged with migraine than were women younger than 20. Diagnosis was also more likely in white women than in any other race or ethnicity. A strong association was found between migraine discharge codes and all types of stroke discharge codes (odds ratio [OR], 15.8). Ischemic stroke had the strongest association (OR, 30.7), while no association was found for cerebral venous thrombosis and subarachnoid hemorrhage. A significant association was also seen with myocardial infarction (OR, 4.9), heart disease (OR, 2.1), pulmonary embolus (OR, 3.1), deep venous thrombosis (OR, 2.4), and thrombophilia (OR, 3.6). In addition, migraine was associated with vascular risk factors such as diabetes (OR, 2.3), hypertension (OR, 3.6), and smoking (OR, 2.7). Some pregnancy-related complications were also associated with migraine. An association was observed regarding preeclampsia/gestational hypertension (OR, 2.3) but not for gestational diabetes (OR, 1.0).
A multivariable logistic regression analysis was also performed to include age and to separate preeclampsia diagnoses from stroke, vascular diagnoses, hypertension, smoking, and diabetes. Related diagnoses, such as heart disease, acute myocardial infarction, or venous thromboembolism and pulmonary embolus were combined into one variable. Increasing age (OR, 1.03), diabetes (OR, 1.96), myocardial infarction/heart disease (OR, 2.11), preeclampsia (OR, 2.29), smoking (OR, 2.85), pulmonary embolus/venous thromboembolism (OR, 3.23), and stroke (OR, 15.05) were all independently associated with migraine discharge codes.
“The most logical explanation for the relation between migraine and vascular disease during pregnancy is the existence of overlapping pathophysiological mechanisms in both conditions, compounded by the physiological changes during pregnancy,” Dr. Bushnell and coauthors commented.