Cryptogenic stroke and migraine: using probabilistic independence and machine learning to uncover latent sources of disease from the electronic health record

Abstract

Migraine is a common but complex neurological disorder that doubles the lifetime risk of cryptogenic stroke (CS). However, this relationship remains poorly characterized, and few clinical guidelines exist to reduce this associated risk. We therefore propose a data-driven approach to extract probabilistically-independent sources from electronic health record (EHR) data and create a 10-year risk-predictive model for CS in migraine patients. These sources represent external latent variables acting on the causal graph constructed from the EHR data and approximate root causes of CS in our population. A random forest model trained on patient expressions of these sources demonstrated good accuracy (ROC 0.771) and identified the top 10 most predictive sources of CS in migraine patients. These sources revealed that pharmacologic interventions were the most important factor in minimizing CS risk in our population and identified a factor related to allergic rhinitis as a potential causative source of CS in migraine patients.

10 pages, 6 figures, 1 table, LaTeX. Manuscript has been peer-reviewed and accepted for presentation at the 2025 AMIA Symposium and publication in the AMIA proceedings. Changes from previous versions are minor and include fixed typos, adjusted formatting, rewording of some technical details, and a lengthier discussion regarding the source related to allergic rhinitis, per reviewer comments