Ischaemic stroke may symptomatically manifest as migraine aura

Waters, Michael J.; Cheong, Edmund; Jannes, Jim; Kleinig, Timothy

doi:10.1016/j.jocn.2018.07.017

Cited by 20 publications

(17 citation statements)

References 8 publications

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“…The presence of a headache after transient neurological symptoms does not necessarily mean that these symptoms are consistent with a diagnosis of MA, because a migraine-like attack (with or without aura) can also be triggered by ischaemic vascular events. 19 Although not extensively investigated, the risk of TIA seems to be increased in people with MA, but not in those with MO. 20 Misdiagnosis of migraine aura as TIA may represent a limitation in the proper study of this association.…”

Section: Migraine and The Risk Of Transient Ischaemic Attacksmentioning

confidence: 99%

Migraine and risk of stroke

Øie

Kurth

Gulati

et al. 2020

J Neurol Neurosurg Psychiatry

147

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Migraine and stroke are two common and heterogeneous neurovascular disorders responsible for a significant burden for those affected and a great economic cost for the society. There is growing evidence that migraine increases the overall risk of cerebrovascular diseases. In this review, based on available literature through a PubMed search, we found that ischaemic stroke in people with migraine is strongly associated with migraine with aura, young age, female sex, use of oral contraceptives and smoking habits. The risk of transient ischaemic attack also seems to be increased in people with migraine, although this issue has not been extensively investigated. Although migraine appears to be associated with haemorrhagic stroke, the migraine aura status has a small influence on this relationship. Neuroimaging studies have revealed a higher prevalence of asymptomatic structural brain lesions in people with migraine. They are also more likely to have unfavourable vascular risk factors; however, the increased risk of stroke seems to be more apparent among people with migraine without traditional risk factors. The mechanism behind the migraine-stroke association is unknown. In light of the higher risk of stroke in people with migraine with aura, it is important to identify and modify any vascular risk factor. There is currently no direct evidence to support that a migraine prophylactic treatment can reduce future stroke in people with migraine.

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Section: Migraine and The Risk Of Transient Ischaemic Attacksmentioning

confidence: 99%

Migraine and risk of stroke

Øie

Kurth

Gulati

et al. 2020

J Neurol Neurosurg Psychiatry

147

View full text Add to dashboard Cite

show abstract

“…On the one hand, patients with typical migraine with aura should be reassured that the constellations under which spreading depolarizations occur in migraine with aura are almost always benign, and they should not be subjected to inappropriate and potentially dangerous investigations and treatments. On the other hand, if the migraine aura occurs in an unusual constellation, the treating physician should be alert and perform further diagnostic workup, as it may conceal a stroke ( Olesen et al, 1993 ; Klingebiel et al, 2008 ; Waters et al, 2018 ). It is also particularly important to understand that migraine is not a prerequisite for the occurrence of spreading depolarizations, and very many spreading depolarizations do not manifest clinically as migraine auras.…”

Section: Discussionmentioning

confidence: 99%

“…Although most spreading depolarizations that occur in association with migraine aura are unlikely to be primarily vascular in origin, the alert neurologist working in a stroke unit or as a consultant in a cardiology department where there is a high volume of interventions such as cardiac catheterization and atrial ablation will see single cases of migraine aura associated with minor, often pinpoint stroke every year if the patients are carefully interviewed and MRIs are performed ( Olesen et al, 1993 ; Klingebiel et al, 2008 ; Dreier and Reiffurth, 2015 ; Waters et al, 2018 ; Altamura et al, 2021 ). Also, to understand why relatively small strokes can sometimes be accompanied by transient global neurological deficits ( Dreier et al, 2006 ) or why transient focal symptoms can sometimes occur whose representational fields are not in the ischemic zone proper ( Klingebiel et al, 2008 ), it is useful to have an understanding of the spreading-depolarization continuum, because spreading depolarizations are precisely not only local but can spread over large areas of cortex and subcortical gray matter ( James et al, 1999 ; Cain et al, 2017 ; Kaufmann et al, 2017 ; Milakara et al, 2017 ).…”

Section: Brain Activity Changes In the Context Of Spreading Depolariz...mentioning

confidence: 99%

Migraine Aura, Transient Ischemic Attacks, Stroke, and Dying of the Brain Share the Same Key Pathophysiological Process in Neurons Driven by Gibbs–Donnan Forces, Namely Spreading Depolarization

Lemâle

Lückl

Horst

et al. 2022

Front. Cell. Neurosci.

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Neuronal cytotoxic edema is the morphological correlate of the near-complete neuronal battery breakdown called spreading depolarization, or conversely, spreading depolarization is the electrophysiological correlate of the initial, still reversible phase of neuronal cytotoxic edema. Cytotoxic edema and spreading depolarization are thus different modalities of the same process, which represents a metastable universal reference state in the gray matter of the brain close to Gibbs–Donnan equilibrium. Different but merging sections of the spreading-depolarization continuum from short duration waves to intermediate duration waves to terminal waves occur in a plethora of clinical conditions, including migraine aura, ischemic stroke, traumatic brain injury, aneurysmal subarachnoid hemorrhage (aSAH) and delayed cerebral ischemia (DCI), spontaneous intracerebral hemorrhage, subdural hematoma, development of brain death, and the dying process during cardio circulatory arrest. Thus, spreading depolarization represents a prime and simultaneously the most neglected pathophysiological process in acute neurology. Aristides Leão postulated as early as the 1940s that the pathophysiological process in neurons underlying migraine aura is of the same nature as the pathophysiological process in neurons that occurs in response to cerebral circulatory arrest, because he assumed that spreading depolarization occurs in both conditions. With this in mind, it is not surprising that patients with migraine with aura have about a twofold increased risk of stroke, as some spreading depolarizations leading to the patient percept of migraine aura could be caused by cerebral ischemia. However, it is in the nature of spreading depolarization that it can have different etiologies and not all spreading depolarizations arise because of ischemia. Spreading depolarization is observed as a negative direct current (DC) shift and associated with different changes in spontaneous brain activity in the alternating current (AC) band of the electrocorticogram. These are non-spreading depression and spreading activity depression and epileptiform activity. The same spreading depolarization wave may be associated with different activity changes in adjacent brain regions. Here, we review the basal mechanism underlying spreading depolarization and the associated activity changes. Using original recordings in animals and patients, we illustrate that the associated changes in spontaneous activity are by no means trivial, but pose unsolved mechanistic puzzles and require proper scientific analysis.

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“…Following exclusion of 53 items, 109 items comprising 504 cases were reviewed. A total of 53 items were labeled as "Cases-Structural" (70 individual case reports in total) (Table S1), 34 as "Cases-Nonstructural" (50 individual case reports in total) (Table S2), and 19 as "Groups" (384 cases in total) [99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116][117] (Table S3). In addition, from two case series of three patients, 118,119 three cases were included in "Cases-Structural," and three in "Cases-Other."…”

Section: Re Sultsmentioning

confidence: 99%

Symptomatic migraine: A systematic review to establish a clinically important diagnostic entity

et al. 2021

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Objective To determine if a clinical presentation indistinguishable from migraine can occur due to an underlying condition or pathology, that is, "symptomatic migraine." Background It is currently not clear whether migraine truly can be caused by an underlying condition or pathology. Characterization of the etiology and clinical features of possible symptomatic migraine is of significant clinical importance and further may help elucidate the pathophysiology of migraine. Methods We devised operational diagnostic criteria for “symptomatic migraine” and “possible symptomatic migraine” requiring strong evidence for a causal relation between underlying cause and migraine symptoms adhering strictly to diagnostic criteria. PubMed was searched for case reports of symptomatic migraine from inception to March 2020. Only articles published in English or German were included. No restrictions were placed on study design. Relevant references in the articles were also included. Papers were systematically reviewed by two independent reviewers for detailed clinical features of migraine as well as the proposed underlying conditions and the effects of treatment of these conditions. Results Our search retrieved 1726 items. After screening, 109 papers comprising 504 cases were reviewed in detail. Eleven patients with migraine with aura (MWA) fulfilled our working criteria for symptomatic migraine, and 39 patients fulfilled our criteria for possible symptomatic migraine. The most common etiologies of symptomatic migraine were arteriovenous malformations, carotid stenosis, dissection or aneurysm, brain infarctions, meningioma, and various intra‐axial tumors. Conclusions Symptomatic MWA, indistinguishable from idiopathic MWA, may occur due to cortical lesions or microembolization. We found no clear evidence supporting the existence of symptomatic migraine without aura although we did identify possible cases. Our findings are limited by the available literature, and we suggest that prospective studies are needed.

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Ischaemic stroke may symptomatically manifest as migraine aura

Cited by 20 publications

References 8 publications

Migraine and risk of stroke

Migraine and risk of stroke

Migraine Aura, Transient Ischemic Attacks, Stroke, and Dying of the Brain Share the Same Key Pathophysiological Process in Neurons Driven by Gibbs–Donnan Forces, Namely Spreading Depolarization

Symptomatic migraine: A systematic review to establish a clinically important diagnostic entity

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