Abstract DP238: Migraine and Intracerebral Hemorrhage Outcomes: A National Inpatient Analysis

Introduction: Migraine is a neurovascular disorder associated with cerebrovascular events, yet its effect on intracerebral hemorrhage outcomes remains unclear. Shared pathophysiological mechanisms, could influence outcomes following intracerebral hemorrhage. Methods: This retrospective cohort study used the National Inpatient Sample (NIS) database (2016–2021) to identify non-traumatic intracerebral hemorrhage hospitalizations with and without migraine. The primary outcome was in-hospital mortality, and secondary outcomes included length of stay, favorable discharge, and intracerebral hemorrhage-related complications (e.g., shunt placement and pneumonia). Propensity score matching (1:1) was performed and outcomes were analyzed using survey-weighted logistic regression. Sensitivity analyses were conducted for migraine subtypes and intracerebral hemorrhage location. Results: Of 76,775 intracerebral hemorrhage hospitalizations (national weighted estimate: 383,874), 1,376 (weighted: 6,880) had a secondary migraine diagnosis, representing a 1.8% of the sample. Cohort showed a mean age of 67.6 (SD 15.1) and slight male predominance (52.7%). After successfully matching 2,694 intracerebral hemorrhage hospitalizations in a 1:1 ratio, those with migraine had lower in-hospital mortality (10.0% vs. 16.5%, OR=0.56 [95%CI=0.43–0.72]), higher favorable discharge rates (36.7% vs. 28.1%, OR=1.48 [95%CI=1.24-1.78]), and lower pneumonia prevalence (3.6% vs. 5.8%, OR=0.61 [95%CI=0.41–0.91]). Sensitivity analyses revealed similar effects of migraine in outcomes for cortical intracerebral hemorrhage (mortality: OR=0.49 [95%CI=0.26–0.91]; and favorable discharge: OR=1.46 [95%CI=1.01–2.13]), and for migraine without aura (mortality: OR=0.31[CI:0.11-0.87] and favorable discharge: OR= 1.79[1.08-2.97]) and non-specified migraine (mortality: OR=0.56[CI:0.43-0.73] and favorable discharge: OR=1.44[1.20-1.74]) subgroups. Conclusions: Migraine as a concomitant diagnosis during intracerebral hemorrhage hospitalization was associated with improved in-hospital outcomes, including lower mortality, better discharge disposition. These findings may reflect shared mechanisms of migraine that influence outcomes after spontaneous intracerebral hemorrhage. The pattern observed in sensitivity analyses raise the possibility of cortical spreading depolarization may contribute to these findings but warrant further investigation.