Migraine Increases Risk of Perioperative Stroke and Hospital Readmission

MedicalResearch.com Interview with:

Dr. Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia, Harvard Medical School Clinical Director, Critical Care Division

Dr. Matthias Eikermann

Dr. Matthias Eikermann, MD, PhD
Associate Professor of Anaesthesia
Harvard Medical School
Clinical Director, Critical Care Division 

MedicalResearch.com: What is the background for this study?

Response: Up to one fifth of the general population have migraine, a primary, chronic-intermittent headache disorder affecting the neuronal and vascular systems and characterized by severe headache accompanied by nausea and/or sensory hypersensitivities such as photophobia and phonophobia. In approximately 20-30% of patients, the headache phase is preceded or accompanied by transient focal neurological disturbances presenting as visual symptoms but also sensory, aphasic, or motor symptoms known as migraine aura.

Stroke is responsible for approximately 6.2 million deaths a year and is a leading global cause of long term disability. Considering that more than 50 million patients in hospital and 53 million ambulatory patients undergo surgical procedures in the United States every year.

We found that patients with migraine, particularly migraine with aura, undergoing a surgical procedure are at increased risk of perioperative ischemic stroke and readmission to hospital within 30 days after discharge.

MedicalResearch.com: What are the main findings?

Response: We found that patients with migraine, particularly migraine with aura, undergoing a surgical procedure are at increased risk of perioperative ischemic stroke and readmission to hospital within 30 days after discharge.

MedicalResearch.com: What should readers take away from your report?

Response: GPs, Anesthesiologists and Surgeons should incorporate migraine in the assessment for risk of perioperative stroke.

We have explored our data to identify possible preventable risk factors for perioperative stroke in patients with migraine.

We speculate based on our exploratory data analysis that the use of high dose vasopressors during surgery as well a history of a possible right-to-left shunt may represent modifiable risk factors for perioperative ischemic stroke in patients with migraine with aura.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our results related to preventable risk factors need to be further evaluated since they are biologially plausible: The use of high dose vasopressors during surgery may be an indicator of suboptimal preload and possibly decreased cardiac output, which can further lead to an impairment of cerebral oxygenation despite normalization of mean arterial blood pressure. Meticulous optimization of fluid resuscitation volume during anesthesia and surgery should help to avoid excessive use of vasopressors and its associated increased vulnerability to perioperative stroke. Published data on the association between patent foramen ovale and cryptogenic ischemic stroke or transient ischemic attack are equivocal. In our study, the combination of a history of a possible right-to-left shunt and migraine with aura was associated with a substantial increase in risk for perioperative ischemic stroke, as well as a predictor for perioperative ischemic stroke in patients with migraine.

Our results indicating that migraine is associated with an increased risk of 30 day hospital readmission need also be further explored. Readmissions strain healthcare systems with a large economic burden and serve as performance measurements of clinical care – further studies are needed to better understand how to avoid those readmissions in patients with migraine.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study would not have been possible without the generous support by Jeff and Judy Buzen who made a donation to support this line of research.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

BMJ:

Timm FP, et al “Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital-based registry study” BMJ 2017; DOI: 10.1136/bmj.i6635.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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