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Introduction Migraine symptoms are postulated to improve post-stroke. We aimed to determine post-stroke changes in patients with active migraine pre-stroke, and explored the relation with stroke location and stroke-preventive medication use. Methods Patients with active migraine who had an ischemic stroke were retrieved from three research-cohorts between 2014-2021. By an interview we retrospectively investigated first-year post-stroke changes for those ischemic stroke patients that suffered from migraine pre-stroke. Associations between change in migraine frequency/intensity/aura (decrease, no change, increase), stroke location (posterior location versus other), and use of secondary stroke preventive medication were assessed by ordinal regression with adjustment for confounders. Results We included 78 patients (mean age 48 years, 86% women, 47% with aura). Change in migraine symptomatology was reported by 63 (81%) patients; 51 (81%) noticed a decrease in attack frequency (27 no attacks), and 12 (19%) an increase. Pain intensity change was reported by 18 (35%) patients (50% increase, 50% decrease). Aura symptomatology improved in 4 (11%). Reduced attack frequency was not related to posterior stroke (OR=1.5, 95%CI 0.6–3.9), or preventive medication (antiplatelets OR=1.0, 95%CI 0.2–3.7; coumarin OR=2.7, 95%CI 0.4–20.6). Conclusions Most patients with active pre-stroke migraine experience improvement of their symptoms in the first year after ischemic stroke. This change does not seem to be related to secondary stroke preventive medication or posterior stroke location.

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