Migraine may be linked to perioperative stroke, hospital readmission
Use of high-dose vasopressors during surgery and history of a possible right-to-left shunt might be modifiable risk factors in patients who have migraine with aura, and close postoperative monitoring for early detection of stroke symptoms in high-risk patients is essential, researchers said.
History of migraine, especially migraine with aura, may be associated with increased stroke risk and risk for hospital readmission after surgery, according to a recent study.
Researchers performed a prospective hospital registry study at Massachusetts General Hospital in Boston and two satellite campuses from January 2007 to August 2014 to determine whether risk for perioperative ischemic stroke and subsequent increased hospital readmission rates are associated with migraine in surgical patients. The study's primary outcome was perioperative ischemic stroke within 30 days after surgery. Hospital readmission within 30 days of surgery was the secondary outcome, and postdischarge stroke and neuroanatomical stroke location were exploratory outcomes. The study results were published online by BMJ on Jan. 10.
A total of 124,558 patients who had surgery under general anesthesia and with mechanical ventilation were included in the study. Slightly over half (54.5%) were women, and the mean age was 52.6 years. Of these, 10,179 (8.2%) had any type of migraine diagnosis, 1,278 (12.6%) with aura and 8,901 (87.4%) without. Perioperative ischemic stroke occurred within 30 days of surgery in 771 patients (0.6%), with increased risk seen in patients with migraine versus those without (adjusted odds ratio, 1.75; 95% CI, 1.39 to 2.21). Migraine with aura was associated with higher risk compared to migraine without aura (adjusted odds ratio, 2.61; [95% CI, 1.59 to 4.29] versus 1.62 [95% CI, 1.26 to 2.09], respectively).
The researchers calculated a predicted absolute risk of 2.4 perioperative ischemic strokes for every 1,000 surgical patients and found that this risk was 4.3 for every 1,000 patients with migraine, 3.9 for every 1,000 patients with migraine but no aura, and 6.3 for every 1,000 patients with migraine and aura. Rate of readmission within 30 days of discharge was also higher in patients with migraine (adjusted odds ratio, 1.31; 95% CI, 1.22 to 1.41).
The authors noted that they based their classification of migraine and migraine with aura on ICD-9 codes in the hospitals' data registry and that some patients may have been misclassified. In addition, they pointed out that use of the available ICD-9 codes could have led to inclusion of patients who had the most severe symptoms of aura, possibly a subgroup at higher risk for stroke. However, they concluded that their results indicate that migraine, especially migraine with aura, should be included as a marker for increased ischemic stroke risk, including perioperatively.
They suggested that use of high-dose vasopressors during surgery and history of a possible right-to-left shunt might be modifiable risk factors in patients who have migraine with aura and said that close postoperative monitoring for early detection of stroke symptoms in high-risk patients is essential. Migraine should be included in assessment of perioperative risk in patients preparing for surgery, the authors recommended.