{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T23:41:48Z","timestamp":1792712508523,"version":"4.5.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>While prior studies suggest an increased risk of stroke among individuals with migraine, particularly those with migraine with aura, data on how specific migraine characteristics and comorbidities influence this risk across diverse populations remain limited. The <jats:italic>All of Us<\/jats:italic> database provides a unique opportunity to address this gap given its large sample size and inclusion of historically underrepresented groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional case-control analysis using multivariable regression models accounting for vascular risk factors and comorbidities was performed to compare the risk of stroke between individuals with and without migraine, odds ratios (OR) using a 95% confidence interval (CI) were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Within the <jats:italic>All of Us<\/jats:italic> database, 31,444 individuals received a migraine diagnosis [female\u2009=\u200925,374\/81%, male\u2009=\u20095,391\/17%, other\u2009=\u2009679\/2%; mean (std) age\u2009=\u200954.9 (15.6)] and 379,283 did not have a migraine diagnosis [female\u2009=\u2009222,104\/59%, male\u2009=\u2009149,182\/39%, other\u2009=\u20097,997\/2%; mean (SD) age\u2009=\u200955.9 (17.2)]. The migraine group had a greater proportion of women (81% vs. 59%), a higher proportion of white individuals (61% vs. 55%) and fewer African American individuals (15% vs. 19%). Compared to the non-migraine group, individuals with migraine had higher rates of comorbidities, including depression (46% vs. 12%), diabetes (16% vs. 7%), tobacco use (36% vs. 15%), hyperlipidemia (52% vs. 24%), hypertension (54% vs. 26%), and atrial fibrillation (3% vs. 2%).<\/jats:p><jats:p>A multivariable regression model adjusted for differences between group demographics and comorbidities found that compared to those without migraine, individuals with migraine had a higher risk of overall stroke [OR 1.97, 95% CI (1.88, 2.07)], ischemic stroke [OR 1.38, 95% CI (1.24, 1.53)] and hemorrhagic stroke [OR 1.75, 95% CI (1.60, 1.92)]. Individuals with chronic migraine had a higher risk of overall stroke compared to the non-migraine group [OR 2.56, 95% CI ( 2.32, 2.84)] and compared to episodic migraine [OR 1.90, 95% CI (1.81, 2.00)]. Those with migraine with aura had a higher risk of stroke compared to individuals with migraine without aura [OR 1.33, 95% CI (1.20, 1.48)].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Individuals with migraine, particularly those with chronic migraine had a higher risk of stroke compared to those without migraine and compared to individuals with episodic migraine. The risk of stroke was higher in those with migraine with aura compared to those with migraine without aura even after adjusting for vascular comorbidities. Our analysis, using data from the <jats:italic>All of Us<\/jats:italic> database, confirms previous findings and suggests that while vascular comorbidities are more prevalent in those with migraine, they do not fully account for the increased risk of stroke.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpain.2025.1646142","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T05:50:56Z","timestamp":1759297856000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Migraine is associated with a higher risk of ischemic and hemorrhagic stroke: an analysis of the All of Us database"],"prefix":"10.3389","volume":"6","author":[{"given":"Nick","family":"Seah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine D.","family":"Chong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana M.","family":"Dumitrascu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd J.","family":"Schwedt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhichao","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e020498","DOI":"10.1136\/bmjopen-2017-020498","article-title":"Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects","volume":"8","author":"Mahmoud","year":"2018","journal-title":"BMJ Open"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2346","DOI":"10.1007\/s00415-021-10930-x","article-title":"Myocardial infarction, stroke and cardiovascular mortality among migraine patients: a systematic review and meta-analysis","volume":"269","author":"Ng","year":"2022","journal-title":"J Neurol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s10072-016-2746-z","article-title":"Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies","volume":"38","author":"Hu","year":"2017","journal-title":"Neurol Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1435208","DOI":"10.3389\/fneur.2024.1435208","article-title":"Reviewing migraine-associated pathophysiology and its impact on elevated stroke risk","volume":"15","author":"Ravi","year":"2024","journal-title":"Front Neurol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k96","article-title":"Migraine and risk of cardiovascular diseases: Danish population based matched cohort study","volume":"360","author":"Adelborg","year":"2018","journal-title":"Br Med J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1136\/jnnp-2018-318254","article-title":"Migraine and risk of stroke","volume":"91","author":"\u00d8ie","year":"2020","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1097\/GME.0000000000002311","article-title":"Migraines, vasomotor symptoms, and cardiovascular disease in the coronary artery risk development in young adults study","volume":"31","author":"Kim","year":"2024","journal-title":"Menopause"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e207813","DOI":"10.1212\/WNL.0000000000207813","article-title":"Combined impact of migraine and pregnancy-induced hypertension on long-term risk of premature myocardial infarction and stroke","volume":"102","author":"Hvitfeldt Fuglsang","year":"2024","journal-title":"Neurology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"117269","DOI":"10.1016\/j.atherosclerosis.2023.117269","article-title":"Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women","volume":"384","author":"Rajendran","year":"2023","journal-title":"Atherosclerosis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1111\/head.13796","article-title":"Migraine and ischemic stroke in women. 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