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May 2013

A Questionable Cause of Intracerebral Hemorrhage

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Esenwa and Elkind) and Epidemiology (Dr Elkind), Columbia University Medical Center, New York, New York.

JAMA Neurol. 2013;70(5):653-654. doi:10.1001/jamaneurol.2013.272

In their recent article, Gokhale and colleagues1 described a man with a history of migraines who experienced an intracerebral hemorrhage (ICH). They claimed that this was an example of the amorphous entity termed migraine-associated ICH. However, the differential for an angiogram-negative lobar ICH is wide. It includes hypertensive hemorrhage, cerebral amyloid angiopathy, vascular malformation, aneurysmal rupture, cerebral vein thrombosis, coagulopathy, bleeding tumor, and drugs. There are also other genetic and lifestyle risk factors, of which migraine is not one.2 To our knowledge, there is in fact only 1 prospective study that supports the authors' conclusion. In the Women's Health Study, Kurth and colleagues3 found that women with a history of migraine with aura had an absolute risk increase of 0.003% (hazard ratio, 2.3) for ICH. Because of the low attributable risk, the authors explicitly acknowledged that the study did not provide definitive evidence of association. There is no evidence to support the diagnosis in men.

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