Migraine and risk of stroke

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 (Øie LR, Kurth T, Gulati S, et al Migraine and risk of stroke Journal of Neurology, Neurosurgery & Psychiatry 2020;91:593-604.) , based on available literature through a PubMed search, the authors 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.