Stroke etiology and white matter burden in women with and without migraine

Background: Women with migraine, especially with aura (MA), have a higher risk of white matter hyperintensities (WMH) and ischemic stroke. We aimed to assess differences in stroke etiology between women with and without migraine and the impact of migraine on WMH volume in women with stroke. Methods: We included women aged 40–60 years with a history of ischemic stroke, migraine or both. Stroke etiology was categorized using the TOAST criteria. WMH volume was measured using 3D-FLAIR images. Presence or absence of cerebellar WMH was scored. We used regression analysis to assess differences between groups, with adjustments for age, BMI, hypertension and smoking status. Results: We included 55 women with stroke, 55 with stroke and migraine, and 38 with MA. Women with stroke more often had a history of smoking than those with stroke and migraine (74% vs. 46%, p = 0.004). Stroke of undetermined origin was more common in women with both conditions than with stroke alone (49% vs. 27%, p = 0.019). Periventricular WMH volumes were higher in women with stroke with migraine than in those with MA alone (0.55mL vs. 0.42mL, B = 0.21, 95%CI = 0.01–0.41, p = 0.040). There were no differences in deep WMH volume and cerebellar WMH between groups. Importantly, the addition of migraine did not affect WMH volume in women who had experienced stroke. Conclusion: Women with both stroke and migraine more often had undetermined etiology of stroke compared to women with stroke alone, and in women with stroke alone smoking was a more prevalent risk factor. Migraine did not contribute to increased WMH volume in women with stroke.