Migraine patients should be cautiously followed for risk factors leading to cardiovascular disease

Abstract

Migraine and ischemic strokes (IS) are two of the most prevalent diseases worldwide. Around 12 to 21% of women suffer migraine attacks and 2 in 1,000 per year people (older than 65 years-old) will have an acute ischemic stroke [1][2][3] . Therefore, frequently, neurologists and emergency medicine personnel face the challenge of dealing with symptoms that could be attributed to both pathologies, or even struggling to decide the best tests and therapy for the patient. Besides having some coincident symptomatology, for long researchers have been searching for a possible causal relation between these diseases, however the overlap of some risk factors makes the road even more tortuous. The aim of this review was not only to dissect some of the more compelling evidence based on data regarding this association, but also to discuss on how it would impact the clinical practice. We approached the subject in a problem-based fashion, discussing four of the most intriguing questions about the matter, always focusing on the clinical implications. In the end, we have introduced some diagnostic and therapeutic clinical pearls, presenting a stepped approach to difficult cases. CAN MIGRAINE BE A VASCULAR RISK FACTOR?The question about migraine being a risk factor for IS has been asked in several previous studies for the past half century. Two cohort studies 4,5 and three meta-analysis 6-8 consistently reported doubled risk for IS among migraine patients, with more robust evidence among young female patients with associated aura. This interesting observation would make us ABSTRACTMigraine and ischemic strokes are two of the most prevalent diseases worldwide. Besides having a coincident symptomatology, for long researchers have been searching for a possible causal relation between these diseases. Current evidence based on data suggest that patients with aura migraine could have a doubled risk of developing an ischemic stroke, when compared to the rest of the population. At the same time, migraine sufferers apparently have higher incidences of risk factors for cardiovascular events. The aim of this review was not only to dissect some of the more compelling evidence based on data regarding this association, but also to discuss the possible clinical and therapeutic implications.Key words: brain ischemia, cerebrovascular disorders, migraine, stroke. RESUMOMigrânea e acidentes vasculares cerebrais isquêmicos (AVCI) são duas das doenças de maior prevalência em todo o mundo. Além de apresentarem alguns sintomas em comum, há muito tempo pesquisadores procuram investigar uma relação causal entre as duas. As informações atuais baseadas em evidência sugerem que pacientes com migrânea com aura podem ter um risco duas vezes maior de desenvolver AVCI, quando comparados com o restante da população. Ao mesmo tempo, aqueles sofrem de migrânea possuem aparentemente maior incidência de fatores de risco para eventos cardiovasculares. O objetivo desta revisão foi não apenas avaliar grande parte das mais importantes e convincentes evidências científica...

Migraine and Stroke: “Vascular” Comorbidity

“…Migraine and ischemic stroke (IS) are two highly prevalent diseases. A relevant proportion of the population (up to 21% of women, 6% of men) suffer from migraine attacks and 2/1,000 over 65 year-olds will have an IS ( 1 – 3 ). It has been common knowledge for a long time in clinical practice that some migraine with aura (MA) attacks may mimic cerebrovascular accident symptomatology and that migraine aura may, although rarely, act as an acute precipitant of an IS, the so-called “migrainous infarction.”…”