Migraine patients are highly susceptible to perioperative ischemic stroke

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Migraine patients are highly susceptible to perioperative ischemic stroke

A recent study published in the British Medical Journal has revealed that patients suffering from a migraine since a long time are vulnerable to the ischemic stroke after surgery, causing more hospital readmissions. Approximately 20% of the general population is affected by migraine and hence, are exposed to an increased risk for ischemic stroke. The perioperative ischemic stroke risk ranges from 0.6 % to 7.4% among patients who have undergone surgery. Higher stroke rates are detected in patients who had cardiac and vascular surgery. The perioperative mortality risk increases 8 times after the perioperative stroke.

Matthias Eikermann, MD, PhD, associate professor of anaesthesia at Harvard Medical School and clinical director of the Critical Care Division at Massachusetts General Hospital in Boston, with his colleagues studied the link between migraine history and the risk for perioperative ischemic stroke. In a prospective registry study, they studied 30-day hospital readmission rates in surgical patients. Statistical analysis showed that out of 124,558 surgical patients, 8.2% were suffering from migraine and among this 12.6 % had a history of migraine with aura. Among these, the incidence of ischemic stroke within 30 days of surgery was 0.6%.

Migraine with aura (adjusted odds ratio (OR), 2.61) was concluded as a stronger risk factor than migraine without aura (adjusted OR, 1.62; p<0.001). Results described were based on above findings and explained as the predicted absolute risk for perioperative ischemic stroke is 2.4 per 1000 patients overall, migraine without aura increases this risk to 3.9 per 1000, and migraine with aura increases the risk even further, to 6.3 per 1000. History of migraine seems to be associated with an increased risk for hospital readmission within 30 days (adjusted OR, 1.31). An exploratory analysis found that twice as many patients suffering from migraine were readmitted for stroke as compared to patients without migraine (2.0% vs 1.0%; p=0.005).

Dr Eikermann told Clinical Pain Advisor that, “stroke was not the only reason for readmission. Patients with migraine were also readmitted for gastrointestinal symptoms and pain". It was culminated from the study that approximately 1 in 5 people are suffering from migraine, imposing an essential perioperative complication in the surgical population.

"The long-term goal is to individualize the anaesthetic regimen to minimize the risk of stroke in migraine patients. In an exploratory analysis study, it was found that using high doses of vasopressors may increase the risk of stroke in migraineurs. Patients with migraine should talk to their anesthesiologist about their migraine history to minimize the risk of stroke," Dr Eikermann said. The author's study relating to diagnosis of migraine with aura or without aura was established using International Classification of Diseases, 9th edition, codes, which may be prone to misclassification.

Source:

Neurology advisor

Link to the source:

http://www.neurologyadvisor.com/migraine-and-headache/patients-with-migraine-face-greater-stroke-hospital-readmission-risk/article/634717/

Original title of article:

Perioperative Stroke Risk High in Patients With Migraine

Authors:

Matthias Eikermann et al.

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