Introducing a risk score for predicting ischemic stroke in migraine with or without visual aura

AimMigraine with aura is a risk factor for ischemic stroke. To further assess this risk factor in relation to ischemic stroke, along with other risk factors, we created the migraine associated risk of stroke score (MARS+), making it applicable to migraineurs. The risk score includes vascular risk factors, migraine characteristics and medications used in migraine patients.MethodsWe prospectively evaluated participants in Atherosclerosis Risk in Communities Cohort (ARIC) with a history of migraine. In this population, we tested the association of potential risk factors for ischemic stroke using a Cox proportional hazards model. The coefficient of each variable was divided by the lowest β value and rounded to the nearest integer. The sum of the weighted score of the reported risk factors was found and categorized into two prognostic groups.ResultsWe assessed migraine characteristics (aura, migraine frequency and duration) and medications that were in current use by participants, mean ± SD age 58 ± 5.5 years, 86% white, 14% black and 77% women (ergot alkaloids, triptans, hormone replacement therapy, sympathomimetics, steroids, selective serotonin reuptake inhibitors and opioids), in addition to traditional risk factors. Based on the points derived from the significant factors we assigned age ≥65 years = 1, non-white race = 2, hypertension = 2, diabetes = 3, body mass index ≥30 = 2, atrial fibrillation = 2, use of steroid medications = 3, use of selective serotonin reuptake inhibitor medications = 1, opioids = 2, presence of aura = 2 and duration <5 years = 1 to total 21 points. A cut-off of MARS+ ≥5 was considered as a lifetime high risk for ischemic stroke based on receiver operating characteristic curve and Youden's index. Of the 1485 participants with migraine, 112 had an ischemic stroke. MARS+ ≥5 revealed a hazard ratio of 4.09 (95% confidence interval = 2.67-6.26).ConclusionsThe MARS+ score is used to predict ischemic stroke in middle-aged migraine sufferers. This risk score, in addition to generalizability, includes factors such as migraine characteristics and medications that may increase stroke risk.