Migraine Headache and Ischemic Stroke Risk: An Updated Meta-analysis

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Presentation transcript:

Migraine Headache and Ischemic Stroke Risk: An Updated Meta-analysis June T. Spector, MD, MPH, Susan R. Kahn, MD, MSc, Miranda R. Jones, BA, Monisha Jayakumar, BDS, MPH, Deepan Dalal, MBBS, MPH, Saman Nazarian, MD The American Journal of Medicine Volume 123, Issue 7, Pages 612-624 (July 2010) DOI: 10.1016/j.amjmed.2009.12.021 Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 1 Selection process for study inclusion in the meta-analysis. The American Journal of Medicine 2010 123, 612-624DOI: (10.1016/j.amjmed.2009.12.021) Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 2 (A) Methodological quality summary for 14 case-control studies. Colors in table correspond to reviewers' consensus answers to questions at the top of the figure for each study, with green indciating “yes,” yellow indicating “uncertain,” and red indicating “no.” (B) Methodological quality summary for 8 cohort studies. Colors in table correspond to reviewers' consensus answers to questions at the top of the figure for each study, with green indicating “yes,” yellow indicating “uncertain,” and red indicating “no.” LTFU = loss to follow-up. The American Journal of Medicine 2010 123, 612-624DOI: (10.1016/j.amjmed.2009.12.021) Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 3 (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke in participants with migraine with aura versus no migraine. Size of data markers indicates weight of study. (C) Adjusted effect estimates of ischemic stroke in participants with migraine without aura versus no migraine. Size of data markers indicates weight of study. (D) Adjusted effect estimates of ischemic stroke in studies of only women participants with any migraine versus no migraine. Size of data markers indicates weight of study. (E) Adjusted effect estimates of ischemic stroke in low bias studies in participants with any migraine versus no migraine. Size of data markers indicates weight of study. The American Journal of Medicine 2010 123, 612-624DOI: (10.1016/j.amjmed.2009.12.021) Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 3 (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke in participants with migraine with aura versus no migraine. Size of data markers indicates weight of study. (C) Adjusted effect estimates of ischemic stroke in participants with migraine without aura versus no migraine. Size of data markers indicates weight of study. (D) Adjusted effect estimates of ischemic stroke in studies of only women participants with any migraine versus no migraine. Size of data markers indicates weight of study. (E) Adjusted effect estimates of ischemic stroke in low bias studies in participants with any migraine versus no migraine. Size of data markers indicates weight of study. The American Journal of Medicine 2010 123, 612-624DOI: (10.1016/j.amjmed.2009.12.021) Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 3 (A) Adjusted effect estimates of ischemic stroke in participants with any migraine versus no migraine. Size of data markers indicates weight of study. (B) Adjusted effect estimates of ischemic stroke in participants with migraine with aura versus no migraine. Size of data markers indicates weight of study. (C) Adjusted effect estimates of ischemic stroke in participants with migraine without aura versus no migraine. Size of data markers indicates weight of study. (D) Adjusted effect estimates of ischemic stroke in studies of only women participants with any migraine versus no migraine. Size of data markers indicates weight of study. (E) Adjusted effect estimates of ischemic stroke in low bias studies in participants with any migraine versus no migraine. Size of data markers indicates weight of study. The American Journal of Medicine 2010 123, 612-624DOI: (10.1016/j.amjmed.2009.12.021) Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 4 Influence of removing studies one by one on adjusted effect estimates of ischemic stroke. Circles are effect estimates and horizontal dotted lines 95% confidence intervals for meta-analysis of the studies listed, excluding the study indicated by the circle. The vertical line in the center is the summary effect estimate including all listed studies. The American Journal of Medicine 2010 123, 612-624DOI: (10.1016/j.amjmed.2009.12.021) Copyright © 2010 Elsevier Inc. Terms and Conditions

Figure 5 Funnel plot of studies reporting adjusted odds ratios. Plots are log standard error of effect estimate by adjusted effect estimate, centered on the pooled adjusted effect estimate. The pseudo 95% confidence interval corresponds to the expected 95% confidence interval for a given standard error. OR = odds ratio. The American Journal of Medicine 2010 123, 612-624DOI: (10.1016/j.amjmed.2009.12.021) Copyright © 2010 Elsevier Inc. Terms and Conditions