DELAYED CEREBRAL ISCHAEMIA AFTER SUBARACHNOID HAEMORRHAGE IN PATIENTS WITH A HISTORY OF MIGRAINE

Background: Delayed cerebral ischemia (DCI) is a major contributor to the high morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Spreading depolarizations may play a role in DCI pathophysiology. Since migraine patients are probably more susceptible to spreading depolarizations, we investigated whether aSAH patients with migraine are at increased risk for DCI. Methods: We included aSAH patients from three hospitals in the Netherlands. We assessed life-time migraine history with a short screener. DCI was defined as neurological deterioration lasting >1 hour not attributable to other causes by diagnostic work-up. Adjustments were made for possible confounders in multivariable Cox regression analyses and adjusted hazard ratios (aHR) were calculated. We assessed the interaction effects of age and sex.Results: We included 542 aSAH patients (mean age 57 years, 72% women) of whom 103 (19%) had a history of migraine (61 with aura). Patients with migraine were not at increased risk of developing DCI compared to patients without migraine (22% versus 28%, aHR:0.78; 95%CI:0.49u20131.25). Additionally, no increased risk was found in migraine patients with possible aura (aHR:0.62; 95%CI:0.32-1.19), in women (aHR:0.72; 95%CI:0.43-1.21, pinteraction=0.376), or in patients <50 years (aHR:1.62; 95%CI:0.77-3.42), although numbers in these subgroups were limited. We found an interaction between migraine and age with an increased risk of DCI among young migraine patients (Pinteraction=0.011).Conclusion: Patients with migraine are not at increased risk of DCI. Future studies should focus in particular on young SAH patients, in whom there might be an association between migraine history and development of DCI.