As strokes with "unknown causes" rise in young adults, researchers just found a link with one surprising condition that's common in women.
This “Non-Traditional” Risk Factor Could Double Your Chance of Stroke Before 50
Published on May 14, 2025
For years, medical experts have focused on long-established risk factors—such as high blood pressure or obesity—when it comes to strokes and proactive care to prevent one. A new study, however, just unveiled more possibilities…particularly when it comes to adults on the relatively younger side.
Published last month in the American Stroke Association’s medical journal, aptly named Stroke, the study involved 523 European individuals who had experienced a cryptogenic ischemic stroke, as well as 523 others without a history of stroke. The participants ranged in age from 18 to 49 years old, and the study used nearly a decade’s worth of data.
The research is particularly timely, given that ischemic (defined as clot-caused) strokes have been growing in the adult population between the ages of 18 to 49, according to a corresponding press release. Additionally, data shows stroke is the fifth most common cause of death in the U.S.
Further, said lead researcher Dr. Jukka Putaala, head of the stroke unit at Helsinki, Finland’s University Hospital: “Up to half of all ischemic strokes in younger adults are of unknown causes, and they are more common in women. For effective prevention, careful and routine assessment of both traditional and nontraditional risk factors in younger people is critical.”
With this in mind, a large team of doctors from multiple European countries and the U.S. gathered to analyze the likelihood of a stroke event based on:
- 12 “traditional” stroke risk factors, including smoking, cardiovascular disease, incidence of type 2 diabetes, high blood pressure, abdominal obesity, heavy alcohol consumption, and psychosocial stress, plus several others
- 10 “nontraditional” factors, including incidence of “autoimmune disease, inflammatory bowel disease, chronic kidney disease, chronic liver disease [or] … the presence of migraine with aura,” as well as cancer
- five risk factors specifically focused on women, such as whether they’d been pregnant and/or had experienced pregnancy complications, in addition to incidence of gestational diabetes, gestational hypertension, and current use of estrogen therapy “through any route of administration.” (Estrogen supplementation has been associated with blood clots among women, which is one reason some healthcare providers practice caution when prescribing it.)
- Additionally, they examined how a heart defect, called patent foramen ovale (PFO), could affect a patient’s stroke chances. The defect is a cavity that’s located between the heart’s upper chambers.
The study concluded the top cryptogenic ischemic stroke risk factors for patients with the patent foramen ovale defect were:
- Migraine with aura (45.8%)
- Abdominal obesity (22.5%)
- Unhealthy diet (9.4%)
Meanwhile, top risk factors for individuals without the heart defect were identified as:
- Migraine with aura (22.7% risk)
- Current smoking (21.9% risk)
- Abdominal obesity (21.1%)
Migraine headaches with aura “emerged as the most prominent individual risk factor” for unexplained strokes, “particularly in female patients.”
Migraine with aura—defined by the Cleveland Clinic as a migraine where a “warning” occurs beforehand via changes in vision, tingling or numbness, or other symptoms—was associated with a 45.8% risk level in patients with the patent foramen ovale heart defect. Participants without PFO saw a 22.7% risk level.
Based on these findings, Dr. Putaala commented: “We should be asking young women if they have a history of migraine headaches and about other non-traditional risk factors.” He also noted that the new findings should encourage healthcare professionals to “develop a more tailored approach to risk factor assessment and management.”
In patients without the PFO heart defect, “each additional traditional risk factor increased stroke risk by 41%, while each non-traditional risk factor increased stroke risk by 70%,” said the press release. And when it came to risk factors associated with women, those also increased stroke risk “independent of traditional and non-traditional risk factors” by 70%.
The researchers believe theirs is the first study “to provide sex- and age-specific estimates on the contribution of a broad range of traditional, non-traditional, and female-specific risk factors” in regard to unexplained strokes among young adults.
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