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Impact of Aura and Status Migrainosus on Readmissions for Vascular Events After Migraine Admission
Author(s) -
Velickovic Ostojic Lili,
Liang John W.,
Sheikh Huma U.,
Dhamoon Mandip S.
Publication year - 2018
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13347
Subject(s) - medicine , subarachnoid hemorrhage , migraine , aura , migraine with aura , hazard ratio , intracerebral hemorrhage , proportional hazards model , stroke (engine) , retrospective cohort study , cohort , emergency medicine , confidence interval , mechanical engineering , engineering
Objective —To estimate readmission rates for acute ischemic stroke (AIS), transient ischemic attack (TIA), subarachnoid hemorrhage, and intracerebral hemorrhage after an index admission for migraine, using nationally representative data. Methods —The Nationwide Readmissions Database was designed to analyze readmissions for all payers and uninsured, with data on >14 million US admissions in 2013. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify index migraine admissions with and without aura or status migrainosus, and readmissions for cerebrovascular events. Cox proportional hazards regression was performed for each outcome with aura and status migrainosus as main predictors, adjusting for age and vascular risk factors. Results —Out of 12,448 index admissions for migraine, 9972 (80.1%) were women, mean age was 45.5 ± 14.8 years, aura was present in 3038 (24.41%), and status migrainosus in 1798 (14.44%). The 30‐day readmission rate (per 100,000 index admissions) was 154 for ischemic stroke, 86 for TIA, 42 for subarachnoid hemorrhage, and 17 for intracranial hemorrhage. In unadjusted models, aura was significantly associated with TIA (hazard ratio 2.43, 95% CI 1.39‐4.24), but not AIS (1.26, 0.73‐2.18), intracranial hemorrhage (1.86, 0.45‐7.79) or subarachnoid hemorrhage (1.85, 0.44‐7.75). When adjusting for age and vascular risk factors, aura remained significantly associated with TIA (2.13, 1.22‐3.74). Status, in adjusted models, was significantly associated with subarachnoid hemorrhage readmission (4.83, 1.09‐21.42). Conclusions —In this large, nationally representative retrospective cohort study, migraine admission with aura was independently associated with TIA readmission, and status migrainosus was independently associated with subarachnoid hemorrhage. Further research would clarify the role of misdiagnosis and causal relationships underlying these strong associations.