Migraine and ischemic stroke: possible pathogenic relation

Abstract

Migraine, especially migraine with aura, is an established risk factor for ischemic lesions of the brain. This disorder affects about 15% of people in developed countries and is three times more common in women than in men. The risk of ischemic stroke appears to be higher in migraine with aura than in migraine without aura. An association between migraine and ischemic stroke has been observed for many years but exact mechanisms by which migraine can lead to stroke are currently still under investigation. A significant association between migraine and ischemic stroke has been demonstrated in population and case-control studies. The observation that stroke may occur during migraine attacks prompts to speculation that migraine may directly cause an ischemic event (migrainous infarct). Alternatively, as stroke occurs more frequently during the interictal phase of migraine, an indirect relation between the two diseases might exist. Both ischemic stroke and migraine with aura might be consequences of many underlying vascular disorders. Meta-analysis also demonstrates that subjects with migraine are at higher risk of showing white matter abnormalities on Magnetic Resonance images. Ultimately, it will be important to determine whether migraine with aura is a modifiable risk factor for ischemic stroke and if preventive medications for migraine or antiplatelet therapy might reduce the risk of ischemic stroke in patients with migraine with aura. In the present paper, I will review epidemiological studies, discuss potential mechanisms of migraine-induced stroke and comorbid ischemic stroke.