Migraine Associated with Perioperative Ischemic Stroke

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Surgical patients with a history of migraine face increased risk for perioperative ischemic stroke, according to a study in The BMJ.

Researchers examined the medical records of nearly 125,000 patients who had surgery under general anesthesia with mechanical ventilation at three Massachusetts hospitals between 2007 and 2014. Some 8% had recorded migraine diagnoses; of these, 13% had migraine with aura.

Overall, 0.6% of patients had a perioperative ischemic stroke within 30 days after surgery. Compared with patients without migraine, those with migraine had a 75% increased risk for stroke (0.9% among those with migraine vs. 0.6% among those without). The increased risk for stroke was significant for migraine with and without aura, although the risk with aura was somewhat higher.

The authors calculate that for every 1000 surgical patients, there would be 2.4 ischemic strokes. This would increase to 3.9 strokes for patients with migraine without aura and 6.3 for those with aura.

The authors conclude: “We suggest that migraine should be included in the perioperative risk assessment.”