Abstract
BackgroundAn association between migraine and stroke has been suggested for a long period, although conclusive evidence has not been reported. Several theories about hypercoagulability have been proposed for the association of ischemic stroke and migraine especially migraine with aura. This study aimed to assess blood coagulability in patients with migraine.ResultsMean serum levels of protein S and anti-thrombin III were significantly lower in migraine patients compared to control subjects. Migraine patients showed abnormal MRI findings in the form of white matter hyper-intense lesions and ischemic foci compared to healthy controls. A significant negative correlation was detected between serum protein C level and intensity of migraine headache. Also, a significant correlation was found between deficient serum protein S and abnormal findings in brain MRI. Serum protein C deficiency is an independent predictor for migraine intensity grade.ConclusionsThere is an association between migraine and hypercoagulability, which may indicate increased risk of cerebral ischemic events in migraine patients and suggest adding prophylactic therapy to the management strategies of such patients.
Highlights
An association between migraine and stroke has been suggested for a long period, conclusive evidence has not been reported
There are numerous theories linking migraine with hypercoagulability mainly related to cortical spreading depression (CSD) which may lead to weakening of the blood–brain barrier and endothelial damage, eliciting the inflammatory cascade in neurons and glial cells
These CSD-related changes create thrombophilic complications. Another theory suggested that migraine aura is equivalent to a transient ischemic attack (TIA), ischemia which is induced by CSD followed by platelet aggregation and microemboli may cause either aura or TIA [3]
Summary
An association between migraine and stroke has been suggested for a long period, conclusive evidence has not been reported. There is a complex bidirectional relation between migraine and stroke especially migraine with aura (MA), including migraine as risk factor of stroke, migraine as a complication of cerebral ischemia, There are numerous theories linking migraine with hypercoagulability mainly related to cortical spreading depression (CSD) which may lead to weakening of the blood–brain barrier and endothelial damage, eliciting the inflammatory cascade in neurons and glial cells. Another theory suggested that migraine aura is equivalent to a transient ischemic attack (TIA), ischemia which is induced by CSD followed by platelet aggregation and microemboli may cause either aura or TIA [3]
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