Stroke risk in migraine 2023

Inspired by Liao et al 2023.[1]

MDPI – Molecular Diversity Preservation International
LGTD 2005 – Longitudinal Generation Tracking Database 2005
NHIRD – National Health Insurance Research Database
aHR– adjusted hazard ratio

key to acronyms

This is another one of those large retrospective cohort trials from Taiwan. Thanks to Martin Allbright for spotting it before it was listed on PubMed. From the title of the blog, you can see that this one concerns stroke risk in patients with migraine, and you may recall that stroke risk has figured twice before here: a reduced risk associated with acupuncture use in patients with depression;[2] and patients with fibromyalgia;[3] both of these studies coming from Taiwan as well.

This paper is published in the International Journal of Environmental Research and Public Health, which is an MDPI journal with an impact factor of 4.614. MDPI now publishes 420 open access journals, though originally it was launched in 1996 as a non-profit organisation in Basel for the promotion and preservation of the diversity of chemical compound samples, hence the acronym stands for Molecular Diversity Preservation International.

I was a little surprised to read ‘Acupuncture is effective…’ in the title of this paper, since this is observational research, so not matter how compelling the data, we cannot be certain about attribution of cause and effect. The title should be ‘Acupuncture in patients with migraine is associated with…’ But now I am giving you a clue to the result without any detail.

So, this data comes from the LGTD 2005, which is a random sample of 2 million from the NHIRD in Taiwan. I have written before about the fact that the vast majority of the population in Taiwan are on the same national health insurance database.

Newly diagnosed patients with migraine were sought between the start of 2000 and the end of 2018 (a 19-year period). 123 691 patients were found. Less than 10% of this cohort used acupuncture. After exclusions and propensity score matching, 1354 patients were left in each cohort ie those that used acupuncture and those that did not. These patients were followed in the database to determine the incidence of stroke up until the end of 2018.

Compared to the non-acupuncture cohort, the patients with migraine who received acupuncture had a 60% lower risk of stroke (aHR 0.4). This is numerically a little better than the reduction in stroke risk for patients with depression (aHR 0.49) and fibromyalgia (aHR 0.53).

Considering that migraines affect more than 1 billion people worldwide, the lifetime incidence of stroke is around 25%, and the risk of stroke is around 50% higher in patients with migraine, acupuncture use could be associated with saving 225 million strokes over a typical lifetime if all patients with migraine were given acupuncture treatment. That is a lot of acupuncture treatment and a lot of reduced morbidity. Doing a very simple health economic evaluation, I reckon that if the cost of treating 2 patients with acupuncture for their migraines costs less than the cost of care for a typical stroke, then we would be saving money globally by treating all patients affected by migraine.

References

1          Liao C-C, Chien C-H, Shih Y-H, et al. Acupuncture Is Effective at Reducing the Risk of Stroke in Patients with Migraines: A Real-World, Large-Scale Cohort Study with 19-Years of Follow-Up. Int J Environ Res Public Health 2023;20:1690. doi:10.3390/ijerph20031690

2          Chen L-Y, Yen H-R, Sun M-F, et al. Acupuncture treatment is associated with a decreased risk of developing stroke in patients with depression: A propensity-score matched cohort study. J Affect Disord 2019;250:298–306. doi:10.1016/j.jad.2019.03.020

3          Huang M, Yen H-R, Lin C, et al. Acupuncture decreased the risk of stroke among patients with fibromyalgia in Taiwan: A nationwide matched cohort study. PLOS ONE 2020;15:e0239703. doi:10.1371/journal.pone.0239703

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Declaration of interests MC