From migraine to stroke

Abstract

An association between migraine and ischemic stroke has been observed for many years but the exact mechanisms by which migraine can lead to stroke are currently still under investigation. Migraine seems to affect neurovascular factors and substances that increase the risk of stroke during and in between migraine attacks. Ischemic stroke can occur as a complication of an attack of migraine with aura. Epidemiological studies suggest that vascular risk factors are increased in migraineurs, thus increasing the incidence of stroke. Another important issue is a patent foramen ovale (PFO), which is a well-known risk factor for stroke and which, on the other hand, seems to be more frequent in migraineurs than in people without. The purpose of this review is to summarize the current literature linking the two neurological diseases: migraine and stroke.

Migraine Headache and Ischemic Stroke Risk: An Updated Meta-analysis

“…Migraine with aura is characterized by cortical spreading depression, oligemia, and changes in vascular perfusion 42. Changes in vascular perfusion may be associated with vasospasm, which could lead to cerebral hypo-perfusion and ischemic stroke 51. In comparison to our study, the Etminan et al study also reported a statistically significant, albeit reduced, risk of stroke for migraine without aura (pooled RR 1.83; 95% CI 1.06, 3.15).…”

“…In addition, not all studies adjusted for oral contraceptive or post-menopausal hormone use, which is likely to confound the relationship between migraine in women and ischemic stroke, as estrogen-containing therapies have been used to treat certain types of migraines 56,57. Finally, migraine is more common in women,3,4 and vasoactive medications used to treat migraines, such as triptans, may predispose to ischemic stroke 42,51…”

Migraine-related ischemic stroke?

“…Epidemiological studies have shown that patients with migraine have more cardiovascular risk factors; they are more likely to smoke and have an increased rate of hyperlipidaemia and hypertension (3). Also, patent foramen ovale (PFO), which might be regarded as a risk factor for embolic strokes, has been shown to be more common in patients with MA compared with non-migraneurs (11). Migraine has also been linked to cervical artery dissection (CAD).…”

Clinical impact of migraine for the management of glaucoma patients

“…This suggests that cortical visual field defects in people with migraine may be vascular in origin. There is evidence to support an increased susceptibility to ischaemic cerebrovascular events in migraine sufferers, including a greater risk of stroke (Katsarava et al, 2008;Kurth et al, 2012), increased prevalence of rare physiological causes of cerebral infarct such as arterial dissections (Rist et al, 2011) and patent foramen ovale (Schwedt et al, 2008), and increased prevalence of vascular risk factors such as pro-thrombotic factors or markers of blood vessel wall dysfunction (Tietjen and Khubchandani, 2015). All of these factors could contribute to clinical and sub-clinical brain lesions seen in migraine sufferers using magnetic resonance imaging (reviewed by Schwedt and Dodick, 2009), and, if the occipital region is involved, could potentially explain the occurrence of homonymous visual field losses in people with migraine.…”