Younger adults under the age of 50 may face more danger from unexpected stroke risk factors—like migraines with aura or hidden blood clots—than from traditional causes such as high blood pressure or smoking.
A new study published in Stroke, the journal of the American Stroke Association, found that these nontraditional risks may actually double the chances of a stroke in this age group.
Researchers from Europe, led by Dr. Jukka Putaala from Helsinki University Hospital, examined over 1,000 adults between 18 and 49 years old.
About half of the participants had suffered an ischemic stroke with no obvious cause, also called a cryptogenic stroke. The other half had no history of stroke and were used for comparison.
Traditional risk factors for stroke include high blood pressure, smoking, obesity, high cholesterol, and type 2 diabetes. But in recent years, doctors have seen more strokes among young adults who don’t have any of these known issues.
Instead, nontraditional risk factors like migraines with aura, blood clots in veins, chronic kidney or liver disease, and certain types of cancer seem to play a bigger role—especially for people with a heart condition called patent foramen ovale (PFO). A PFO is a small opening between the heart’s upper chambers that usually causes no symptoms but can increase stroke risk.
Here’s what the study found:
Among participants without a PFO, each additional traditional risk factor increased stroke risk by 41%, and each nontraditional risk factor raised it by 70%.
Among participants with a PFO, traditional risk factors only raised stroke risk by 18%, but nontraditional risk factors more than doubled the odds.
Female-specific factors such as pregnancy complications or gestational diabetes increased stroke risk by 70% regardless of PFO status.
The study also looked at which risk factors contributed most to overall stroke cases. In people without a PFO, traditional risk factors explained 65% of cases. But in people with a PFO, nontraditional factors were more important, accounting for 49% of cases.
One of the most striking findings was the role of migraine with aura. This type of migraine, which includes visual or sensory disturbances, was the leading nontraditional risk factor for stroke in young adults. It accounted for:
- 46% of strokes in people with a PFO
- 23% of strokes in people without a PFO
Dr. Putaala said the findings highlight the need for doctors to ask younger patients, especially women, about migraines and other less obvious risk factors when assessing stroke risk.
“Up to half of ischemic strokes in young adults have no clear cause, and they’re more common in women,” he said. “We need to pay attention to these nontraditional risk factors to prevent strokes before they happen.”
Dr. Tracy Madsen, a stroke researcher at the University of Vermont who was not involved in the study, agrees. She said the research is important because it breaks stroke data down by age and sex, which can lead to better prevention strategies.
“Younger women may have a higher risk of stroke than younger men,” she noted. “We need to screen and educate patients more thoroughly throughout their lives.”
The study, called SECRETO, was conducted across 19 hospitals in 13 European countries and ran from 2013 to 2022. Researchers matched 523 stroke patients with 523 stroke-free individuals of similar age and background.
They studied a total of 27 risk factors—12 traditional, 10 nontraditional, and five specific to women—to see which ones were most important in explaining unexplained strokes.
Though the study is large and detailed, it had some limitations. It was observational, so it can’t prove cause and effect. Also, it relied on patient-reported health history, which may not always be accurate. And since 95% of participants were white Europeans, the results may not fully apply to other racial or ethnic groups.
Still, the findings suggest a major shift in how doctors might approach stroke prevention in younger adults. Rather than focusing only on well-known risks like blood pressure and cholesterol, physicians may need to screen for migraines, PFO, and female-specific factors, which could be just as—if not more—important for this age group.
If you care about stroke, please read studies that diets high in flavonoids could help reduce stroke risk, and MIND diet could slow down cognitive decline after stroke.
For more health information, please see recent studies about antioxidants that could help reduce the risk of dementia, and tea and coffee may help lower your risk of stroke, dementia.
The research findings can be found in Stroke.
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