Migraine and cerebrovascular diseases: Epidemiology, pathophysiological, and clinical considerations

Abstract

Migraine and cerebrovascular diseases are disabling disorders, which are possibly closely interrelated. Heterogeneous and scattered evidence in literature remains a challenge. We searched for systematic reviews including diverse cerebrovascular events in migraineurs and reported relevant original studies to update the evidence when necessary. The studies show that migraine is associated with increased risk of transient ischemic attacks, any stroke, and possibly hemorrhagic stroke. In addition, migraine with aura increases the risk of ischemic stroke and white matter abnormalities. Migraine without aura increases the risk of cervical artery dissection as a cause of ischemic stroke. Groups with specific risk profiles are women, young people, smokers, and oral contraceptive users. The pathophysiology of the association remains uncertain. However, genetic and environmental factors may be involved in intricate mechanisms responsible for oxidative stress, vascular dysfunction and, ultimately, vascular events. In conclusion, migraine is a potential risk factor for cerebrovascular diseases. Migraineurs should be carefully evaluated considering their vascular risk assessment based on current evidence, so that healthcare professionals can provide appropriate and individualized management of other cardiovascular risk factors, notably quitting smoking and restricting use of oral contraceptives.

Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura

“…Disordered hemodynamics and paradoxical embolism have been proposed among other mechanisms to explain the increased risk of stroke in migraine patients, principally in patients with MA. [3,30] Besides, when migraine patients, particularly those with MA, experience stroke they display a reduced mismatch between the infarcted and the hypoperfused territories, suggesting a high vulnerability to the ischemic damage. [31,32] In this scenario, it would be important to establish the hemodynamic profile of MA patients.…”

“…[2] Among other mechanisms, high prevalence of patent foramen ovale (PFO) and of genetic thrombophilic mutations and impairment of cerebral hemodynamics have been proposed to subtend this pathological link. [3]…”

Adult Migraine Hospital Admission Trends in Finland: A Nationwide Registry Study

“…Considering that the age of the admitted patients remained stable but their comorbidity burden, and particularly the frequency of stroke risk factors increased, we suggest that the trend may have been influenced by the known association between migraine and stroke. Not only is migraine one of the most common stroke mimics [7,8], it is also associated with stroke pathophysiology and occurrence in a way that has become better known and acknowledged during the recent decades [8,15]. Furthermore, clinical diagnoses are not always accurate [16].…”

Triptans for Migraine Patients With Vascular Risks: New Insights, New Options

“…[34][35][36][37] What risk may be associated with migraine without aura remains a point of controversy? [34][35][36][37] What risk may be associated with migraine without aura remains a point of controversy?…”

“…Triptans and Ischemic Stroke.-MWA approximately doubles the risk of ischemic stroke. [34][35][36][37] What risk may be associated with migraine without aura remains a point of controversy? The migraine-associated stroke risk is higher in young women and is increased by the use of estrogen-based oral contraceptives (OC) and smoking.…”