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Abstract Details

Clinical Manifestations of Stroke in Migraineurs
Headache Posters (7:00 AM-5:00 PM)
Migraine is an established risk factor for ischemic stroke, but is also considered a common stroke mimic, potentially leading to challenges in triage when these individuals present acutely with neurologic symptoms in the setting of a migrainous headache. Clinical clues pointing toward the emergency of stroke in patients with history of migraine are not well established in the neurology literature.
Characterize the frequency of symptoms associated with migraine among patients with acute ischemic stroke (AIS), and assess the influence of an established diagnosis of migraine on time-to-presentation to the emergency department and time-to-diagnosis of stroke with brain MRI.
We performed a retrospective cohort study of all adult patients admitted to a single academic medical center for AIS from January 2016 to June 2017. Patients with a final diagnosis of AIS or transient ischemic attack were included. Among 349 patients with AIS/TIA, 28 patients had a pre-existing diagnosis of migraine. Data were collected on the frequency of common migraine symptoms and accompaniments, time-to-presentation to the ED, and time-to-MRI. 

Migraineurs were more likely than non-migraineurs to present with headache (p<0.001), photophobia (p=0.028), migraine aura (p< 0.001) or nonspecific visual symptoms (p= 0.006) at the time of presentation for AIS. There was no significant difference between cohorts experiencing nausea or dizziness/lightheadedness.  There were no significant differences in time-to-presentation to the ED (p= 0.472) or time-to-MRI (p= 0.39) between migraineurs and non-migraineurs.

Patients with a history of migraine who presented with AIS were more likely to report common migraine symptoms of headache, photophobia, migraine aura, and nonspecific visual symptoms at the time of presentation compared to non-migraneurs. The relatively high frequency of these symptoms in the setting of AIS among migraineurs suggests that clinicians should not be dissuaded from continuing to evaluate and treat for AIS when these symptoms are present.

Merrill Maguire Brady Moe, MD
Dr. Brady has nothing to disclose.
Lester Y. Leung, MD (Tufts Medical Center) Dr. Leung has received research support from NIH.