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Kathleen Ries Merikangas, PhD; Brenda T. Fenton, MSc; Shou Hsia Cheng, PhD; Marilyn J. Stolar, MA; Neil Risch, PhD

Arch Neurol. 1997;54(4):362-368.

Abstract
Objective
To examine the association between stroke and migraine in an epidemiological study.

Data Sources and Design
The National Health and Nutrition Examination Survey baseline and first follow-up data were used to investigate cross-sectional and longitudinal associations between headache/migraine and stroke.

Setting
Study participants from a national probability sample of the civilian noninstitutionalized population of the United States.

Main Outcome Measure
Self-reported physician diagnosis of stroke.

Results
After controlling for established risk factors for stroke (hypertension, diabetes, heart disease, and gender), both migraine and severe nonspecific headache were associated with a significantly increased risk for stroke reported at follow-up. The risk for stroke associated with migraine decreased as the age at stroke increased.

Conclusions
Our results strengthen previous evidence regarding a nonrandom association of both headache and migraine with stroke, particularly among young women. To our knowledge, this is the first systematic examination in a large-scale prospective epidemiological study of men and women with sufficient statistical power to test the association between migraine and stroke in women. Severe headache and migraine should be considered as risk factors for the development of stroke, particularly in the absence of other well-established stroke risk factors. Further investigation is required to identify the putative mechanisms underlying comorbidity of migraine and stroke.

Author Affiliations
From the Genetic Epidemiology Research Unit (Dr Merikangas and Mss Fenton and Stolar) and Laboratory of Epidemiology and Public Health (Dr Merikangas), Yale University School of Medicine, New Haven, Conn; Institute of Public Health, National Taiwan University, Taipei (Dr Cheng); and the Department of Genetics, Stanford University, Stanford, Calif (Dr Risch).

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