Abstract Details

Title Tale of Caution: Identifying Migrainous Infarction Using Database

Topic General Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-068

Objective

Our objective was to identify patients with migrainous infarction, i.e. infarction attributed to migraine aura at our institution.

Background Migraine with aura patients commonly experience transient stroke-like symptoms, but are also at higher risk for stroke. Ischemic stroke in a migraine sufferer may be categorized as cerebral infarction of other cause coexisting with migraine, cerebral infarction of other cause presenting with symptoms resembling migraine with aura, or cerebral infarction occurring during the course of a typical attack of migraine with aura. Only the last fulfills criteria for migrainous infarction.

Design/Methods We analyzed a healthcare database using codes for migrainous infarction in ICD-9 and ICD-10. The individual charts were reviewed for evidence of migrainous infarction using International Headache society criteria, migraine aura and stroke history.

Results In our study we identified 36 patients diagnosed with migrainous infarction and reviewed their charts. Three of the patients (8 %) met the criteria by having a cerebral infarction occurring during the course of a typical attack of migraine with aura. Seven had cerebral infarction of other cause with history of migraine. The remaining 26 patients (72%) did not have stroke at all. Of these, 14 had normal neuroimaging and 12 had normal neurological exams without neuroimaging. 10 patients had normal MRI and therefore only migraine with aura without stroke, 12 patients had a headache after stroke and of those 10 had no preceding migraine history.

Conclusions This study supports previous observations that migrainous infarction is rare. Additionally, researchers solely using ICD codes to identify migrainous infarction may be led astray, as most patients given this diagnosis in our review did not meet the specified criteria. This may be due to coding errors or misunderstanding of the narrow criteria for this condition. We recommend detailed provider education and proper use of ICD-10 coding.

Authors/Disclosures
Anusha Mannava, MD PRESENTER	No disclosure on file
Daniel Krashin, MD (Seattle VA)	Dr. Krashin has nothing to disclose.
Jennifer Wax, MD (Confluence Health)	No disclosure on file
Jenna Kanter, MD	No disclosure on file
	No disclosure on file
Natalia Murinova, MD, FAAN (University Of Washington)	Dr. Murinova has nothing to disclose.

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