Migraine and the Risk for Stroke and Cardiovascular Disease
Migraine and the Risk for Stroke and Cardiovascular Disease
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DOI：
10.1007/s11886-014-0524-1
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发表时间：
2014-09-01
影响因子：
3.7
通讯作者：
Kurth, Tobias
中科院分区：
文献类型：
--
作者：
Sacco, Simona;Kurth, Tobias
大量数据表明偏头痛和心血管疾病之间存在关联。大多数现有数据表明，先兆偏头痛可被认为是缺血性中风的危险因素，而无先兆偏头痛不能被可靠地认为是这样。频繁发作和近期偏头痛发作与缺血性中风风险增加有关。此外，在年轻的缺血性卒中患者中，先兆偏头痛是整体血管事件复发和缺血性卒中复发的独立危险因素。此外，偏头痛患者短暂性脑缺血发作的风险似乎也会增加，尽管这一问题尚未得到广泛的研究。一些研究也指出了偏头痛和出血性中风之间可能存在的联系。尽管这些单独研究的结果相互矛盾，但他们的荟萃分析表明，偏头痛与出血性中风（包括脑内和蛛网膜下腔出血）风险增加1.5倍有关。一些研究已经确定偏头痛也可能是心血管事件的风险因素，而其他研究则得出了负面结果。一项荟萃分析并未显示偏头痛患者与非偏头痛患者心肌梗死风险增加，但随后的数据显示偏头痛与心脏缺血性疾病之间存在关联。一些研究还发现偏头痛与血管死亡率以及大脑和心脏以外的其他部位的血管疾病有关。一些研究还表明，与非偏头痛患者相比，偏头痛患者有更高的无症状白质脑损伤负担，根据一些研究，也有脑磁共振梗死样病变。偏头痛与心血管疾病之间关系的潜在机制尚不清楚。可能的解释可能依赖于偏头痛患者特殊的血管脆弱性，这可能有助于偏头痛的发病机制，并且在存在一些其他未知因素的情况下，随着时间的推移，也可能有助于心血管疾病的发展。目前，还没有可靠的特征可以表明在整个偏头痛人群中，哪些受试者会发生血管事件，到目前为止，还没有推荐用于偏头痛血管预防的药物，除非有其他明确的适应症。一般来说，有偏头痛病史的脑卒中患者的急性治疗和二级预防措施与其他脑卒中患者没有什么不同。目前没有直接的证据支持偏头痛预防治疗在二级预防中会降低未来中风的风险。
Numerous data have pointed to an association between migraine and cardiovascular diseases. The majority of the available data have indicated that migraine with aura can be considered a risk factor for ischemic stroke, whereas migraine without aura cannot be reliably considered as such. High frequency of attacks and a recent onset of migraine have been related to an increased ischemic stroke risk. In addition, in young subjects with ischemic stroke migraine with aura represents an independent risk factor of overall recurrent vascular events and of recurrent ischemic stroke. Also the risk of transient ischemic attack seems to be increased in migraineurs, although this issue has not been extensively investigated. Several studies have also addressed the possible association between migraine and hemorrhagic stroke. Although the results of these individual studies were conflicting, their meta-analysis showed that migraine is associated with a 1.5-fold increase in the risk of hemorrhagic stroke (including intracerebral and subarachnoid hemorrhage). Some studies have identified migraine also as a possible risk factor for cardiac vascular events while others have yielded negative results. A meta-analysis did not show an increased risk of myocardial infarction in subjects with any migraine vs no migraine but subsequently, data has pointed to an association between any migraine with cardiac ischemic disease. Migraine has also been associated by some studies with vascular mortality and with vascular diseases in regions other than the brain and the heart. Several studies have also indicated that compared with nonmigraineurs, migraineurs have a higher burden of asymptomatic white matter brain lesions and, according to some studies, also infarct-like lesions at brain magnetic resonance. The mechanisms underlying the relationship between migraine and cardiovascular disease are still unclear. The possible explanation may rely on a peculiar vascular vulnerability of migraineurs that may contribute to the pathogenesis of migraine and, in the presence of some other unknown factors may also contribute, over time, to the development of cardiovascular disease. At the moment, there are no reliable features that may indicate which subjects, across the overall migraine population, will develop vascular events and so far, no drugs are recommended for the vascular prevention in migraineurs unless other clear indications are present. In general, the acute treatment and the secondary prevention measures of a patient with stroke who has a history of migraine do not differ from that of other stroke patients. There is currently no direct evidence to support that a migraine prophylactic treatment will reduce future stroke risk in secondary prevention.