Migraineurs’ Likelihood Of Getting Stroke Graded

Migraine Blog Stroke

Migraineurs with Aura Double the Risk of Stroke…and more… (1)

A study conducted by the senior neurologists at the Loyola University Medical Center has put forth its findings that:

  • People who experience migraines with auras are at roughly double the risk of ischemic strokes.
  • The study also arrived at the shocking conclusion that such migraineurs as those who smoke were thrice as likely to have stroke in their lives.
  • Migraineurs who smoked and used birth control pills were 7 times more likely to suffer strokes.
  • Migraines also pegged a person’s risk of heart attacks and arterial claudication – a condition that causes poor circulation of blood in the legs and limb extremes causing pain.

The conclusion was put out after the results several independent studies were analysed. This meta-analysis has brought out the direct link between migraines and stroke risk. This and similar other studies have been discussed by lead neurologists Dr. Michael Star and Jose Biller M.D at the Loyola Medical Center in the chapter Headache and Migraine Biology and Management.

As per Drs. Star and Biller, “Taking all of these possible explanations into account, the research may point to stroke and migraine sharing a reciprocal causal relationship.” (2) Ischemic strokes or brain attacks cause brain cell death by the limiting or totally stopping the supply of blood to certain brain tissues. Most often an ischemic stroke can be caused by thrombosis or the obstruction of blood vessel by a blood clot forming locally. Almost 85% of all strokes are of ischemic nature (thus making them the most common types of stroke). Some evidence also exists showing a link between migraines and hemorrhagic strokes. Hemorrhagic strokes are caused by rupture of blood vessels of the brain and are considered the more deadly of stroke types.

So far the biology that exists and underlies the relationship between migraines with aura and strokes has been sketchy and poorly defined at best. According to the neurologists, “There is a significant amount of research attempting to further elucidate this multifaceted relationship.” (3)

Through these studies the researchers have proposed several explanations that could explain the linkage between migraines with aura and stroke occurrence:

  1.  Increased risk of cardiovascular diseases in migraineurs
  2. Low levels of HDL or good cholesterol in migraineurs
  3. High levels of c-reactive protein
  4. Presence of specific genes that predispose them to migraines and strokes
  5. Consumption of certain medications that pegs the migraineurs risk of stroke
  6. A phase-phenomenon that occurs in migraine attacks called cortical spreading depression during which strokes occur. During this phase there occurs a slowly propagated wave of depolarization, followed by depression of brain activity setting into motion changes in neural and vascular function.

SOURCES

1.     Woman Having Headache At Home; Stock Photos; Image by Marin; Web April 2015; http://www.freedigitalphotos.net/images/woman-having-headache-at-home-photo-p173634

2.     People who suffer migraine headaches may be at double the risk of stroke; Science Daily News; Web April 2015; http://www.sciencedaily.com/releases/2015/03/150324111326.htm

3.     People who suffer migraine headaches may be at double the risk of stroke; Loyola Medicine – Newswire; Web April 2015; http://www.loyolamedicine.org/newswire/news/people-who-suffer-migraine-headaches-may-be-double-risk-stroke

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Danger Of Ischemic Stroke In Older Migraineurs

stroke_isc_web Older Migraineurs Have Higher Chances Of Suffering Silent Brain Injuries – (1)

A new study published in the May 15th issue of American Heart and Stroke Association’s medical journal Stroke, suggests that older migraineurs have an double the risk of suffering from silent brain injuries and ischemic stroke than those who do not experience migraines.

Silent strokes can be asymptomatic i.e they do not show symptoms but increase the risk of future strokes. Silent stroke or a silent brain infarction is caused by a blood clot getting into the brain artery and thus interrupting the supply of blood, oxygen and nutrients to brain tissue surrounding the clot thus killing it.

As per Teshamae Monteith, M.D., lead author of the study, “I do not believe migraine sufferers should worry, as the risk of ischemic stroke in people with migraine is considered small. However, those with migraine and vascular risk factors may want to pay even greater attention to lifestyle changes that can reduce stroke risk, such as exercising and eating a low-fat diet with plenty of fruits and vegetables.” (2)

He raised caution that if an older migraineurs had other coexisting conditions like a high blood pressure (hypertension) or a sedentary lifestyle, it would add to the risk factor for suffering silent strokes and brain damage. He thus advised them to take medication to address hypertension and to bring it under control.

The study was a research on diverse ethnic groups including people of Hispanic and African origin. It was a collaborative investigation conducted by University of Miami and Columbia University.

Some of the highlights of the study were as follows: (3)

  • Approximate 40% of the population studied comprised of men.
  • The average age of the population was around 71 years old.
  • 65% of the population under study was of Hispanic origin.
  • Of the 546 studied, 104 had a history of migraines.

Some conclusions arrived at were as:

  • Risk of silent brain infarctions in those with migraine double even after adjusting other stroke risk factors.
  • Migraines with aura were not a deciding factor in measuring risk of silent strokes.
  • No real increase in the volume of white matter/ Small blood vessel anamolies was associated with migraines.
  • Some lesions came across in radiographic images as having ischemic origins but more research was required to confirm this.

According to Monteith, “We still don’t know if treatment for migraines will have an impact on stroke risk reduction, but it may be a good idea to seek treatment from a migraine specialist if your headaches are out of control. (4)

Previous studies indicated migraine could be an important stroke risk factor for younger people.

SOURCES:

  1. Image Credit: Ischemic stroke; Heart & Stroke Foundation – Canada; Web May 2014; http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484151/k.7916/Stroke__Ischemic_stroke.htm
  2. Older migraine sufferers may have more silent brain injury; Science Daily News; Web May 2014; http://www.sciencedaily.com/releases/2014/05/140515163826.htm
  3. Abstract of the study can be accessed at: http://stroke.ahajournals.org/content/early/2014/05/15/STROKEAHA.114.005447.abstract
  4. Older people with migraines ‘more likely to have silent brain injury’; Medical News Today; Web May 2014; http://www.medicalnewstoday.com/articles/276842.php

Details of the study published in AHA journal, Stroke: http://stroke.ahajournals.org/content/early/2014/05/15/STROKEAHA.114.005447.full.pdf+html

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Finally A Stroke Guideline For Women!

Brain-Haemorrage

Hemorrhagic Stroke Risk In Women Addressed By AHA/ASA For The First Time (1)

Recent research has shown that migraineurs and especially those who experience aura are at an increased risk of a stroke (brain hemorrhage) or a heart attack during a migraine episode. My post of June 20th, 2013 speaks of this research (on high risk of stroke among the migraining population): http://bit.ly/1iON349

A stroke may be either ischemic or hemorrhagic in nature. A hemorrhagic stroke is the rupturing of an artery in the brain which results in bleeding in the tissues surrounding the rupture and killing the brain cells there which are devoid of blood, oxygen and nutrition. An ischemic stroke occurs when there is an obstruction like cholesterol or clot in the arteries in the brain. These account for almost 90% of all strokes and are less likely to result in fatality if given immediate attention. However, migraineurs are more susceptible to the deadlier hemorrhagic strokes. (2)

[Read WebMD research on how women with migraine with aura may be at increased risk for an additional type of stroke called hemorrhagic stroke here: http://bit.ly/1cmHW6Y ]

Given that women are more susceptible to migraines with aura, the higher risk of getting a stroke is inherent yet there have been no guidelines to date to address stroke issues in women. Finally a guideline has been issued by The American Heart Association/American Stroke Association for health professionals to prevent strokes in women. Here are a few of the important recommendation highlights you should know:

1. FOR MIGRAINEURS

“Women are four times more likely to have migraines than men, and they often coincide with hormone swings. Migraines alone don’t raise the risk of stroke, but ones with aura do. Using oral contraceptives and smoking raise this risk even more, so the guidelines urge stopping smoking.” (3)

2. FOR ELDERLY WOMEN

Women over 75 years of age should be screened for atrial fibrillation as it is an increased stroke risk factor.

3. FOR WOMEN WITH HYPERTENSION/ HIGH BLOOD PRESSURE

Low dose aspirin or calcium supplement therapy is recommended to cut of stroke risk

4. WOMEN WITH PRE-ECLAMPSIA

Preeclampsia is a condition where a pregnant woman experiences both high blood pressure and a significant increase in protein in her urine. Women with preeclampsia are twice as likely to get a stroke and four times as likely to suffer from high blood pressure later in life. In addition, they are to be treated for weight and cholesterol issues as well as smoking.

5. PREGNANT WOMEN:

Such women who are pregnant and suffer from high blood pressure (>=160/110 mmHg) should be given medication for high blood pressure. Those who are expectant are to be treated for readings in the range of 150-159 mmHg/100-109 mmHg. (4)

SOURCES

  1. Image Credit: Brain Hemorrhage; Sanitarian.net; Web February 2014; http://www.sanitarian.net/wp-content/uploads/2010/11/Brain-Haemorrage.jpg
  2. Study Shows Increased Risk of Heart Disease and Stroke for Migraines With Aura; WebMD.com; Web February 2014; http://www.webmd.com/stroke/news/20100824/migraines-with-aura-may-raise-stroke-risk
  3. Guidelines For Stroke Prevention In Women Issued; Forbes.com; Web February 2014; http://www.forbes.com/sites/robertglatter/2014/02/09/guidelines-for-stroke-prevention-in-women-issued/2/
  4. Stroke prevention in women: guidelines set for the first time; Medical News Today; Web February 2014; http://www.medicalnewstoday.com/articles/272351.php

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What Your Skin Temperature Could Tell About Your Migraine

 

Voila

Lower Temperatures At Body Extremities Could Indicate Migraine In Women (1)

A small scale study observing a women-only population of 41 Finnish women stated that skin temperatures in migraining women can be used as a bio-marker of vascular health since migraineurs are more at risk of developing cardiovascular diseases than healthy populations.

The study’s report published in Autonomic Neuroscience also observed that those with migraines usually have colder nose as well as hand and feet and that it could be attributed to abnormalities in the underlying blood vessels.

Here’s a quick look at the study statistics: (2)

  • Total women studied: 41
  • Those with migraines: 12; 10 with family history of migraines
  • Those without migraines: 29; 9 with family history of migraines

Out of the 12 migraining women 7 were found to experience right-sides migraines and 5 suffered the brunt of left-sided pains. The migraining population experienced visual aura. The study used digital infrared camera to measure skin temperatures in both migraining and control group. Temperatures of the cheeks, nose, forehead, fingertips and toes were taken for comparisons during headache-free periods.

The following results were obtained:

  • Women with right-sided migraines had higher blood pressure.
  • Women with right-sided migraines had lower hand and finger temperatures.
  • Compared to controls (healthy population) there was a 12 deg C (9 deg F) difference in temperatures at the fingertips and nose (extremities)

This could be explained by the fact that migraineurs often have constricted peripheral arteries or impaired functioning of the autonomic nervous system which in turn also makes them more susceptible to cardiovascular diseases.

The average temperature of the nose and hands was about 16 deg C (approx 3.6 degrees F) lower in migraine subjects than controls. Of the migraine patients, 58% had skin temperatures below 30 deg C (or 86 deg F), which is considered a normal skin temperature, in both the nose and fingers.

However, it must be noted that this study was not only small sized but also did not include men. Larger population studies including men and other ethnic groups should be conducted to come to a definitive conclusion. It however, does provide some indication to the direction in which medication development can be done. Biofeedback as an alternative medical therapy makes use of this skin temperature differential in migraineurs to manage pain episodes.

 SOURCES

  1. Image Credit: Business Woman Worried Stock Photo; freedigitalphotos.net; Web January 2014; http://www.freedigitalphotos.net/images/Business_People_g201-Business_Woman_Worried_p76375.html
  2. The Connection Between Migraines and Skin Temperature; The Wall Street Journal; Web January 2013; http://online.wsj.com/news/articles/SB10001424052702303497804579242423379994080

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Launch of Migraine Patch Zecuity Delayed: NuPathe Inc.

nupathe-patch

 

NuPathe Delays The Launch Of Zecuity To Early 2014 (1)

The innovative neuroscience solutions company NuPathe Inc. has announced a delay in the launch of it’s product – a migraine patch that is worn directly on the skin of the upper arm, called Zecuity. The product that was expected to hit the market near the end of this year has now been shifted to early 2014. NuPathe had obtained FDA approval for the marketing of Zecuity earlier this year.

Zecuity is basically a drug delivery system. To be precise it is a sumatriptan iontophoretic trans-dermal system, i.e. it delivers sumatriptan via the skin route using the process of iontophoresis. Iontophoresis involves the delivering of a drug through the skin using low electrical current and so the Zecuity skin patch is embedded with two coin cell lithium batteries which regulate the quantity of current applied and sumatriptan delivered (2). So far, sumatriptan has been known to be delivered through the oral route as pills, injections or as spray via the nasal route. Zecuity is safe for the treatment of acute migraines on patients with or without aura.

Without going into details, the NuPathe CEO Armando Anido, “NuPathe has made substantial progress [toward] securing a partner to maximize the commercial potential of Zecuity. We believe that puts us in a good position to secure a commercial partner and while we have made progress on the partnership and manufacturing fronts, in order to extend our cash runway, we are limiting and delaying certain sales and marketing activities” (3)

However caution is to be exercised with the use of Zecuity if the migraine patient is already on Selective Serotonin Re-uptake Inhibitors (SSRIs), Selective Norepinephrine Inhibitors (SNRIs) or has previously existing conditions such as epilepsy, cardiovascular diseases (heart disease and stroke), diabetes or high cholesterol levels, pregnant or undergoing menopause. (4)

SOURCES

  1. Image Credits: ZECUITY Electronic Drug Patch for Acute Migraines Approved in U.S.Medgadget.com; November 2013; http://www.medgadget.com/2013/01/zecuity-electronic-drug-patch-for-acute-migraines-approved-in-u-s.html
  2. Zecuity; RxList.com; Web November 2013; http://www.rxlist.com/zecuity-drug.htm
  3. NuPathe delays launch of migraine patch; Healthcare Inc. Philadelphia – BizJournal.com; Web November 2013; http://www.bizjournals.com/philadelphia/blog/health-care/2013/11/nupathe-delays-launch-of-migraine-patch.html
  4. Zecuity; zecuity.com; Web November 2013; http://www.zecuity.com/

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Cocktail Vitamin Pill To Treat Migraine To Hit Market Soon: Australia

Vitamin Pill Migraine Photo

Now B vitamins and folate combo to improve enzymes connected to migraines (1)

Australian scientists are in the final stages of testing a pill which could help as many as 20% of all migraine sufferers in the country.

It has been noted that migraineurs often have a mutation in the gene called MTHR (or Methylene Tetra-Hydrofolate Reductase). Due to this mutated gene, there exists a deficiency in the enzyme that the gene is responsible for releasing. This enzyme is actually responsible for regulating levels of folate and homocysteine in the body.

But because there are low levels of the enzyme released due to the mutation of the gene, homocysteine levels cannot be controlled efficiently leading to migraines, increased risk of stroke and cardiovascular disorder.

However, the new pill undergoing final stages of trials, is essentially a cocktail of folate and B vitamins and is being seen to improve the functionality of the enzyme that regulates homocysteine levels

As per lead researcher Professor Lyn Griffiths who is also heading a new unit at the Queensland University of Technology that is investigating gene mutations linked to migraines and other chronic illnesses, “A cofactor for the enzyme is vitamins and we’ve done a phase-one and phase-two trial that showed they could make the enzyme work better.” (2)

The final rounds of phase-three trial include some 600 migraine sufferers to test the efficacy of the pill. Though the pill does not claim that it will cure migraines, especially in those without the gene mutation, it does assure that it will reduce both their frequency as well as the severity of the pain in those who do carry the mutation MTHR.

Note:

Migraine sufferers who want to find out if they have the MTHR gene mutation can have a blood sample taken and sent to the university for a $66 DNA test. Professor Griffiths is urging people who suffer from migraine to join the Headache Register at headacheaustralia.org.au. The site allows sufferers to access the latest in migraine news and research, learn about current and upcoming treatment trials and download a Headache Diary to help them manage their disorder.

SOURCES

  1. Image Credit: Young Female Having Headache by imagerymajestic; freedigitalphotos.net; Web September 2013; http://www.freedigitalphotos.net/images/Emotions_g96-Young_Female_Having_Headache_p74906.html
  2. Hopes vitamin pill will ease crippling migraines; News.com.au; Web September 2013; http://www.news.com.au/lifestyle/health/hopes-vitamin-pill-will-ease-crippling-migraines/story-fneuzlbd-1226721310920

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Migraines Could Lead To White Matter Damage In Brain: New Study

Migraine photo

Abnormalities are common in the signal-sending white matter of migraineurs with aura (1)

A recent analysis of some 19 medical studies put together on migraineurs point that permanent changes likely occur in the brain of those who suffer from migraines and particularly those among them who experience aura – visual or otherwise, before the onset of an attack.

The analysis which was published online in the latest Journal of Neurology concluded that migraineurs with aura were almost two times as likely to have anamolies/abnormalities in the brain structure as those who do not suffer from migraines.

MRIs clearly show white-matter blips and other tissue changes in the migraineurs brain images but how exactly do these neurological variances translate to significant imagery correlate or give a prognosis of progressive deterioration is yet to be seen.

According to Dr. Richard B. Lipton, a neurologist who heads the Montefiore Headache Center in the Bronx, N.Y. “Part of the message I hope to communicate here is: If you have migraine with aura and you have white-matter lesions, they’re probably not a cause of concern.”  (2) However he noted that migraineurs with aura have twice the risk of getting a stroke than non-aura migraineurs

The 19 medical study analysis said the occurrence of tiny lesions that imitate scars left from strokes in aura migraineurs have left them inconclusive because there was no significant evidence of cognitive decline or other neurological symptoms from such lesions or other white-matter anomalies.

In addition, Dr Lipton said that it was good to follow the ‘you never know’ strategy,  further saying, “If you have migraine with aura, certainly you shouldn’t smoke,. Certainly, if you are going to use oral contraceptives, you should use the lowest possible hormonal dose. If you have other stroke risk factors such as hypertension or diabetes or high cholesterol, it becomes particularly important to manage those risk factors.” (2)

What was found to be more disturbing was the uncertainty that surrounds the direction of the correlations. This especially so because it puts forth the reverse question on the table : Is it that the peculiar white-matter phenomena of aura migraineurs on MRI images is what makes for a migraine-prone brain? That is, are the brains of migraine patients different to begin with?

SOURCE:

  1. Image Credits: Sad Middle Aged Woman Suffering From Headache; StockImages; FreeDigitialPhotos.net; Web August 2103; http://www.freedigitalphotos.net/images/Emotions_g96-Sad_Middle_Aged_Woman_Suffering_From_Headache_p150766.html
  2. Migraine could be associated with brain damage, study warns; Los Angeles Times; Web August 2013; http://www.latimes.com/science/sciencenow/la-sci-sn-migraine-brain-damage-20130828,0,7497521.story

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