Migraine and Stroke: What’s the Link? What to Do?

Abstract

Migraine and stroke are common, disabling neurologic disorders, with a high socioeconomic burden. A link between them has been proposed years ago, and various theories have been proposed to explain this bidirectional relation. However, the precise causes remain unclear. We briefly summarize existing hypotheses of this correlation seeking for recommendations for stroke prevention in migraineurs, if any exist. Among the strongest suggested theories of migraine–stroke association are cortical spreading depression, endovascular dysfunction, vasoconstriction, neurogenic inflammation, hypercoagulability, increased prevalence of vascular risk factors, shared genetic defects, cervical artery dissection, and patent foramen ovale. There is no evidence that any preventive therapy in migraineurs should be used to decrease stroke risk, even in most predisposed subset of patients. However, a woman with migraine with aura should be encouraged to cease smoking and avoid taking oral contraceptives with high estrogen doses. We need further investigation to better understand the complexity of migraine–stroke association and to make firm recommendations for the future.

Acute Migraine Prescription Patterns Vary by Baseline Cardiovascular Risk and Clinical Characteristics: A Real-World Evidence Study

“…Although several studies provide conflicting results regarding the safety of triptans, experts do believe that their effectiveness indicates they should be considered as a treatment option for all individuals with migraine because there are no other acute migraine medications that are safe to prescribe to migraine patients with cardiovascular risk factors [15]. For example, the U.S. Food and Drug Administration issued warnings regarding the association of NSAIDs and increased risk of heart attack and stroke, and a study published in 2016 [16] reported that prescription opiates can increase the risk of coronary heart disease and cardiovascular death.…”

Foveal and Peripapillary Vascular Decrement in Migraine With Aura Demonstrated by Optical Coherence Tomography Angiography

“…This is consistent with the report that females with migraine with aura have a higher risk of systemic ischemic complications such as stroke. 39 The pathophysiology of the relationship between gender and ischemia in migraine is not fully understood, but may be related to the effect of estrogen and progesterone on endothelial cells. 40 …”

Migraine with Aura as a Stroke Mimic

“…3 Migraine with aura is a well-documented risk factor of acute stroke. 4 The increased incidence of atrial fibrillation and cardioembolism in patients diagnosed with migraine with aura was linked to acute stroke. 5,6 Migraine with aura can also be found as a stroke mimic during acute stroke management 7 ; however, only a few studies investigated the frequency and characteristics of migraine with aura in patients who initially presented with strokelike symptoms.…”

“…10 Cortical spreading depression, a pathophysiological mechanism of migraine with aura, occurs rather frequently in patients with ischemic stroke. 4 Recent studies showed that migraine with aurainduced stroke may be associated with an increased risk of incidental atrial fibrillation and cardioembolic stroke. 5,6 Because we included patients diagnosed with migraine with aura who initially presented with stroke-like symptoms, all patients underwent ECG and multimodal CT scan, and more than half patients underwent DWI MRI.…”