Migraine-associated risk of cervical artery dissection: A systematic review and meta-analysis
Editor’s note: The research described below comes from a recipient of a 2026 MSC Travel Grant supporting travel to the 68th Annual Scientific Meeting of the American Headache Society. These grants reimburse travel expenses for those who have had their abstract for a presentation or poster accepted at a meeting.
By Muaz Ali, MD, neurology research fellow, Cleveland Clinic Florida.
What is the research gap that your study addresses?
Existing evidence on the relationship between migraine and cervical artery dissection (CeAD) has been inconsistent and fragmented. Prior studies have reported mixed findings, and there has been limited synthesis of whether the association differs by migraine subtype (with aura vs without aura) or by clinical population (stroke vs non-stroke cohorts). Our study addresses this gap by providing an updated systematic review and meta-analysis that quantifies the overall association between migraine and CeAD while also examining these important subgroup differences.
What is your research hypothesis?
We hypothesized that migraine is associated with increased odds of cervical artery dissection and that this association may differ by migraine subtype and clinical setting, with potentially stronger associations in migraine without aura and across both stroke and non-stroke populations.
What methodology did you use to address your research hypothesis?
We used a systematic review and meta-analysis of observational studies. Specifically, we searched PubMed, Embase, Scopus, and Web of Science from inception through January 2026 to identify studies evaluating the association between migraine and cervical artery dissection. We then pooled odds ratios with 95% confidence intervals using a random-effects inverse-variance model, assessed heterogeneity with I² and τ², performed prespecified subgroup analyses by stroke vs non-stroke populations and migraine with vs without aura, and evaluated publication bias using Egger’s regression test.
What are the main results of your study?
Across 13 observational studies including 15,674 participants and 3,443 cervical artery dissection events, migraine was associated with significantly higher odds of cervical artery dissection (OR 1.88, 95% CI 1.52–2.32). The association was seen in both stroke and non-stroke populations. By subtype, migraine without aura showed a significant association (OR 2.17, 95% CI 1.67–2.83), whereas migraine with aura did not (OR 1.23, 95% CI 0.80–1.89). Heterogeneity was substantial, but no publication bias was detected.
What conclusions did you reach based on your results?
Migraine is associated with increased odds of cervical artery dissection, particularly migraine without aura. These findings support migraine as a clinically relevant vascular risk marker and highlight the need for heightened clinical suspicion for dissection in migraine patients with acute neurological symptoms.
What are the limitations of your study?
The main limitations are that the analysis included observational studies, so causality cannot be established, and there was substantial between-study heterogeneity. In addition, definitions of migraine and its subtypes may have varied across studies, and subgroup analyses, particularly by aura phenotype, were based on fewer studies. These factors may limit precision and generalizability of the pooled estimates.
What is the relevance of your study to migraine?
This study is relevant to migraine because it suggests that migraine, particularly migraine without aura, is associated with higher odds of cervical artery dissection. It broadens the understanding of migraine as not only a headache disorder but also a potential vascular risk marker, with important implications for recognizing dissection in migraine patients who present with acute neurological symptoms. These findings may help inform clinical suspicion, risk awareness, and future research into migraine-related vascular mechanisms.