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Possible sex differences are suggested in the pathophysiology underlying the migraine-stroke association, which do not appear to be related to conventional cardiovascular risk factors, according to research published online Nov. 3 in Frontiers in Neurology.

Noting that an increased risk for stroke among patients with migraine has mainly been seen for women, Katie M. Linstra, M.D., from the Leiden University Medical Center in the Netherlands, and colleagues examined sex differences in cardiovascular risk profiles and stroke cause/outcome among 2,492 patients with ischemic stroke from a prospective multicenter study; 17 percent had a history of migraine.

The researchers found no association between a history of migraine and sex differences in the prevalence of conventional cardiovascular risk factors. Compared with women without migraine, women with migraine had an increased risk for stroke at young onset (<50 years: risk ratio, 1.7; 95 percent confidence interval, 1.3 to 2.3). Compared with men without migraine, men with migraine tended to have stroke more often in the TOAST category “other determined etiology” (risk ratio, 1.9; 95 percent confidence interval, 1.0 to 2.7); this increase was not seen for women with migraine. Similar stroke outcome was seen for women with or without migraine (modified Rankin scale [mRS] ≥3: risk ratio, 1.1; 95 percent confidence interval, 0.7 to 1.5); men with migraine had an increased risk for poor outcome compared with those without migraine (mRS ≥3: risk ratio, 1.5; 95 percent confidence interval, 1.0 to 2.1).

“Our explorative study suggests that sex differences in stroke pathophysiology in patients with migraine cannot be explained by differences in conventional vascular risk factors,” the authors write.