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The anesthetic
regimen needs to be personalized so as to reduce the risk of stroke in migraine
patients.
Migraine is a severe headache disorder. A study published in the British Medical Journal revealed that patients with migraine suffering from long time are susceptible to the ischemic stroke after surgery, causing more hospital readmissions. Approximately 20% of the general population is affected by migraine and hence related to an increased risk for ischemic stroke. The perioperative ischemic stroke risk ranges from 0.6 % to 7.4% among patients who has undergone surgery. Higher stroke rates are detected in patients who had a cardiac and vascular surgery. The perioperative mortality risk increases 8 times after perioperative stroke.
Matthias Eikermann, MD, PhD, associate professor of anesthesia at Harvard Medical School and clinical director of the Critical Care Division at Massachusetts General Hospital in Boston, with his colleagues studied the link between migraine history and risk for perioperative ischemic stroke. In a prospective registry study, they studied 30-day hospital readmission rates in surgical patients. Using statistical analysis, they remarked that out of 124,558 surgical patients, 8.2% were suffering from migraine and among these 12.6% had a history of migraine with aura. Among these the incidence of ischemic stroke within 30 days of surgery was 0.6%.
Migraine history appeared as a significant factor for prediction of perioperative ischemic stroke (adjusted odds ratio OR, 1.75). Migraine with aura (adjusted OR, 2.61) was concluded as a stronger risk factor than migraine without aura (adjusted OR, 1.62; P<.001). Results were described which were based on above findings and explained as the predicted absolute risk for perioperative ischemic stroke is 2.4 per 1000 patients overall, migraine without aura increases this risk to 3.9 per 1000, and migraine with aura increases the risk even further, to 6.3 per 1000. History of migraine seem to be associated with an increased risk for hospital readmission within 30 days (adjusted OR, 1.31). An exploratory analysis found that twice as many patients suffering from migraine were readmitted for stroke as compared to patients without migraine (2.0% vs 1.0%; P=.005).
Dr Eikermann told Clinical Pain Advisor that, “Stroke was not the only reason for readmission. Patients with migraine were also readmitted for gastrointestinal symptoms and pain". Migraine is known to be related with gastrointestinal disease, worsening of migraine after surgery is mainly caused by readmissions for pain and gastrointestinal symptoms.
It is culminated from above study that approx. 1 in 5 people are suffering from migraine, which becomes a known risk factor for ischemic stroke, and leads to important perioperative complication in the surgical population.
"The long-term goal is to individualize the anesthetic
regimen in order to minimize the risk of stroke in our migraine patients. In an
exploratory analysis of our study, we found that using high doses of
vasopressors may increase the risk of stroke in migraineurs. Patients with
migraine should talk to their anesthesiologist about their migraine history. If
they are at high risk of stroke, then maybe we can then create an anesthetic
plan that minimizes that risk," Dr Eikermann said. The authors study
relating to diagnosis of migraine with aura or without aura was established
using International Classification of
Diseases, 9th edition, codes, which may be prone
to misclassification.
BMJ
Perioperative Stroke Risk High in Patients With Migraine
Fanny P Timm et al.
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