Migraine and Risk for Perioperative Ischemic Stroke

Authors: Timm FP et al., BMJ 2017 Jan 10; 356:i6635

Surgical patients with migraine, particularly those with aura, are at increased risk for perioperative ischemic stroke and postsurgical 30-day hospital readmission.

To explore the association of migraine with perioperative stroke and 30-day hospital readmission, investigators reviewed prospective hospital registry data for all patients who underwent surgery under general anesthesia with mechanical ventilation during a >7-year period and were extubated at either a tertiary medical center or two affiliated community hospitals. The researchers reviewed medical records for all perioperative ischemic strokes. Readmissions were restricted to the tertiary facility and affiliated hospitals.

Among 124,558 surgical cases included, 10,179 (8.2%) patients had ICD-9 codes for migraine, 1278 (12.6%) of these with aura. Perioperative ischemic stroke was a complication of 771 cases (0.6%), of which 46.2% occurred within the first 2 days after surgery and 25.3% after discharge. Compared with the absolute risk for ischemic stroke among all patients of 2.4 per 1000 cases (95% confidence interval, 2.1–2.8 per 1000), migraine patients had an increased risk: 4.3 per 1000 cases (95% CI, 3.2–5.3). Migraine patients with aura had an absolute risk of 6.3 (95% CI, 3.2–9.5) compared with 3.9 (2.9–5.0) for migraine patients without aura. A total of 10,088 patients were readmitted within 30 days. Migraine patients with or without aura were at higher risk for readmission than those without migraine (adjusted odds ratios, 1.59 [1.33–1.91] and 1.27 [1.18–1.38], respectively).

Building on known associations of migraine with ischemic stroke, these findings suggest that patients with migraine are at particular risk for perioperative ischemic stroke and postsurgical readmission. The underlying factors for the increased perioperative ischemic stroke risk among migraineurs remain to be elucidated. Similarly, a fuller description of reasons for readmission outside of associated billed diagnosis codes is needed, with the goal of identifying modifiable factors to guide the preoperative evaluation and perisurgical care of migraine patients.