Abstract WP252: MARS: Migraine and Retinal Stroke - A Population-Based Cohort Study of 39 Million Patients
Lusk, JB; Song, A; Unnithan, S; Al-Khalidi, H; de Havenon, AH; Biousse, V; Schrag, M; Poli, S; Osazuwa-Peters, N; Xian, Y; Obrien, EC; Mac Grory, BC
Published in: Stroke
Migraine is a risk factor for cerebral ischemic stroke. However, it is not known if migraine is a risk factor for retinal stroke (central retinal artery occlusion, CRAO).
We performed a retrospective cohort study using population-based data from the State Inpatient Databases and State Emergency Department Databases from New York (2006-2015), California (2003-2011), and Florida (2005-2015) to determine the association between hospital-documented migraine and retinal stroke. The primary exposure was hospital-documented migraine. The primary endpoint was hospital-documented CRAO (ICD-9-CM code 362.31 in the primary diagnosis position) and secondary endpoints included BRAO and any retinal artery occlusion (RAO). Cause-specific hazard models were used to model the association between migraine and CRAO.
Of 39,835,024 patients included in the study, 1,109,140 had migraine documented during the exposure window. Patients with migraine were younger (40.2±15.2 vs. 46.9±19.8, standardized difference (SD) 0.38), more likely to be female (81.4% vs. 54.7%, SD 0.6), and had a lower burden of atrial fibrillation (4.5% vs. 6.9%, SD 0.1), chronic kidney disease (1.9% vs. 3.6%, SD 0.2), and congestive cardiac failure (2.7% vs. 5.1%, SD 0.12). Migraine was not associated with CRAO in the primary diagnostic position (adjusted hazard rate (aHR) 1.15 (95% CI: 0.79-1.67). However, it was associated with CRAO in any diagnostic position (aHR 1.39 (95% CI: 1.08-1.78). As positive controls, we replicated previously established associations of migraine with cerebral ischemic stroke (aHR 1.35 (95% CI: 1.32-1.38) and embolic ischemic stroke (aHR 1.15 (95% CI: 1.08-1.22).
In a large, claims-based study, we found a risk-adjusted association between migraine and CRAO considered in any diagnostic position. This finding sets the stage for future work leveraging both outpatient and pharmacy-based claims to further explore this finding.
