Abstract
Background:
The role of migraine headache as a risk factor for intracerebral hemorrhage (ICH) is less well defined than it is for ischemic stroke. Previous studies of migraine and ICH have been limited by the small number of ICH cases analyzed. We hypothesized that a history of migraine headaches is a risk factor for ICH in the ERICH study.
Methods:
ERICH is a multi-center, prospective, case-control study of a racial-ethnically mixed population with ICH. Controls were identified through random digit dialing to match cases by age (+/- 5 years), sex, race/ethnicity (non-Hispanic white, non-Hispanic black and Hispanic) and geographic area. Records of cases were reviewed for past medical history and data on ICH presentation. All cases and controls underwent a comprehensive interview which includes questions regarding headache history. Based on those responses subjects were categorized as having any headache (more than once a month), migraine headaches and migraine with aura.
Results:
A total of 740 cases were matched with controls. Mean age of cases and controls was 58±12 years, 55% were male, 44% non-Hispanic black, 31% non-Hispanic white and 25% Hispanic. Cases were more likely to report a history of migraine (17.3 vs. 14.1%; p=0.076), migraine with aura (5.4 vs. 4.2%; p=0.20) and any headache (38.4 vs. 16.0%; p<0.0001). Cases of ICH with migraine were younger (55.2±13.1 vs. 61.7±14.6 years; p<0.001), more likely to be women (53 vs. 39%; p=0.0004) and reported significantly more substance use, with no difference in ICH location when analyzed by lobar vs. sub-cortical or anterior and posterior circulation distribution.
Conclusion:
A history of headache was associated with ICH in this preliminary analysis of ERICH data, although we were not able to confirm that migraine is a risk factor for ICH. Analysis of additional cases as ERICH continues recruitment may clarify the role of migraine in ICH. The increased prevalence of any headache reported by cases requires cautious interpretation as it may represent recall bias.