Stroke due to small-vessel disease and migraine: A case-control study of a young adult with ischemic stroke population

Background Migraine with aura (MWA) is a risk factor for stroke, but the mechanisms underlying this association remain unclear. Our aim was to assess the association between MWA and cerebral small-vessel disease (CSVD) ischemic stroke after adjustment for vascular risk factors in a population of young patients hospitalized for a first-ever ischemic stroke.Methods Patients aged 18-54 years consecutively hospitalized for a first-ever acute ischemic stroke at the neurovascular unit of our university hospital between January 2017 and July 2021 were included in this retrospective cohort study. CSVD lesions were assessed and classified according to ASCOD (Atherosclerosis, Small-Vessel Disease, Cardiac pathology, Others causes, Dissection) classification criteria.Results In total, 646 patients were included (median (SD) age, 44.03 (9.01) years; 61.8% male) including 115 patients with MWA and 110 patients with migraine without aura (MWoA). Grade S1, potentially causal, CSVD lesions were significantly less frequent in patients with MWA (odds ratio (OR) = 0.35, 95% cofdence interval (CI) = 0.13-0.95, p = 0.048) compared to non-migraine patients in univariate analysis. Logistic regression adjusting for vascular risk factors showed no significant association of CSVD of any grade (S1, S2 or S3 vs. S0) with migraine: OR = 0.78, 95% CI = 0.48-1.28, p = 0.34; MWoA: OR = 0.81, 95% CI = 0.42-1.47, p = 0.51; and MWA: OR = 0.84, 95% CI = 0.43-1.56, p = 0.60, as well as no association of grade S1 CSVD lesions with migraine: OR = 0.91, 95% CI = 0.40-1.92, p = 0.81; MWoA: OR = 1.11, 95% CI = 0.42-2.64, p = 0.81; and MWA: OR = 0.72, 95% CI = 0.20-1.98, p = 0.56.Conclusions In a retrospective study including almost 650 young adults hospitalized for a first ischemic stroke, MWA was not associated with CSVD cause of stroke after adjustment for vascular risk factors.