Comorbid neuropathologies in migraine: an update on cerebrovascular and cardiovascular aspects

Abstract

Several conditions are comorbid with migraine; our review is focused on the relation between migraine, and cerebrovascular and cardiovascular diseases. Despite many studies showed an association between migraine and patent foramen ovale, it is still not known whether its presence might be causal for the migraine pathogenesis and currently its closure cannot be recommended for migraine prevention. On the contrary, conflicting epidemiological data link migraine to arterial hypertension and the use of antihypertensive agents acting on the renin-angiotensin system sounds promising in migraine prevention. A complex bidirectional relation exists between migraine and stroke, and new evidences show a clear association between migraine and coronary heart disease. In both conditions, migraine represents a defined risk factor although the magnitude of the risk varies across the different studies. However, since the risk is low in the general population, it is not possible to identify which migraineurs will develop a cardiovascular or a cerebrovascular event making difficult to apply preventive measures.

Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence from a large, multicenter, cross-sectional survey in Italy (MIRACLES study)

“…Moreover, in most of the previously published studies, headache patients were identified in the population and investigated for a correlation with the actual levels of BP. The criteria used to diagnose migraine or hypertension were often different from the officially recognized criteria [19,29]. These limitations were avoided in the MIRACLES study which was conducted at general practice level; hypertension and migraine were diagnosed according to international guidelines criteria [7,31,32]; and selection criteria were adopted to limit bias.…”

“…Although both hypertension and migraine have a high prevalence in the population, only few studies have investigated their comorbidity [20][21][22][23][24][25][26][27], sometimes with contradictory results [19,28,29]. The MIRACLES (MIgraine and hypeRtension relAtionship: Comorbidity and risk of cerebrovascuLar EventS) cross-sectional survey was designed to provide further information on three issues related to migraine and hypertension.…”

“…In fact, in recent decades, migraine, and specifically migraine with aura, has been associated with an increased risk of ischemic stroke [8][9][10][11][12][13][14][15][16][17][18], which is further increased by cigarette smoking and use of oral contraceptives [19].…”

Migraine prevalence in patients with atrial septal defect

“…A right-to-left shunt (RLS) might be implicated in the pathogenesis of this disorder [3]. However, whether patients with atrial septal defect (ASD) have a high prevalence of migraine remains unclear.…”

Polymorphisms in migraine-associated gene, atp1a2, and ischemic stroke risk in a biracial population: the genetics of early onset stroke study

“…Although the evidence supporting an etiologic relationship between migraine and ischemic stroke risk is substantial (Cole & Kittner 2010; Sacco et al 2012; Sacco et al 2008; Sacco et al 2006), the precise mechanism(s) driving this relationship remains uncertain. Stroke, which typically affects older individuals, can be targeted for prevention by optimizing well-established standard vascular risk factors such as hypertension, diabetes, and hypercholesterolemia, among others.…”