research study was published in the British
‘Risk factors for perioperative stroke in migraine patients should be identified prior to surgery to reduce their occurrence.’
is a common temporary disabling problem
that usually does not have serious consequences. Patients with migraine suffer
from severe, one-sided or both-sided throbbing headache. Unlike a usual
headache, patients of migraine also suffer from symptoms of nausea, vomiting,
blurred vision and increased sensitivity to light and sounds during the attack.
Many people also experience symptoms before the attack, called aura, which
warns them of the upcoming migraine.
Symptoms of aura include flashing of
lights or zigzag vision, or even other symptoms like muscle weakness and
jerking of the body. Newer treatments like sumatriptan
have improved symptoms and are often
used. Patients with frequent attacks are also advised preventive medications.
have suggested an association between migraine and the increased risk of
. The research team from Massachusetts therefore conducted a
study to see if patients with migraine are at a higher risk for ischemic stroke
in the perioperative period, that is, around the time when they undergo
surgery. Ischemic stroke is a type of stroke where a part of the brain gets
damaged due to reduced blood supply.
stroke following a surgery increases the duration of
the hospital stay, prolongs disability as well as increases the chances of
mortality. Therefore, if factors that could predict the chances of the stroke
can be identified, these could be taken care of before the surgery, or
increased precautions can be taken during the surgery to avoid a stroke.
The research team collected
data from 124,558 patients undergoing surgery under general anesthesia over a
period of seven years from Massachusetts, USA. They found that:
- Around 0.6%
patients suffered a stroke within 30 days of the surgery. Patients
undergoing vascular surgery had the highest rate, followed by cardiac
surgery and neurosurgery.
- Among those who
suffered from stroke, 11.9% patients were previously suffering from
- The risk for an ischemic stroke soon after surgery was
higher in patients with prior migraine, especially migraine with aura.
- The risk was
unrelated to other diseases and conditions that could also cause stroke
patients with migraine were at a higher risk for stroke
- The risk for
stroke in migraine patients was highest among those patients with a low
estimated baseline risk of perioperative ischemic stroke
- Patients with
migraine had an increased risk of posterior circulation strokes following
the surgery, but also experienced partial anterior strokes
- Patients with migraine had a higher rate of ischemic
stroke following discharge from the hospital
- Patients with
migraine also had a higher re-admission rate within 30 days of the
surgery. In addition to stroke, the readmission was also due to diseases
of the neurologic, digestive or circulatory system, cerebrovascular
disease, or due to symptoms of pain, syncope/collapse, or nausea/vomiting.
Readmission increases the economic burden on the patient as well as the
health care system.
- Administration of a high dose vasopressor (drug that
increases blood pressure) and a possible right-to-left shunt appeared to
increase the risk of stroke in migraine patients. These are important to note since they can be
prevented or treated, and the stroke avoided. Adequate fluids during and
after anesthesia and surgery could help to reduce the dosage of the
vasopressor, which in turn can reduce the chances of stroke.
The research team
suggests that a genetic predisposition and increased vulnerability to ischemia
in the brain could predispose migraine patients to perioperative stroke. Administration
of general anesthesia, dehydration and stopping of anti-coagulants
just before surgery could be some of the reasons that could increase the risk
of stroke in these patients.
study thus implies that migraine, especially migraine with aura, should be
considered as a risk factor for stroke during the perioperative period, and
extra caution should be taken in these patients during and after surgery.
suggest an individual risk assessment for stroke should be carried out in these
patients before the surgery.
- Timm FP et al. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ 2017;356:i6635