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Published on: June 2, 2014
Progress in clinical neurosciences: Migraine-stroke: a causal relationship, but which direction?
1Division of Neurology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Abstract:
A significant association between migraine and ischemic stroke has been demonstrated in population and case-control studies. The risk of ischemic stroke appears to be higher in migraine with aura (MWA) than migraine without aura (MwoA). Migraine-stroke comprises a number of distinct entities, including migrainous infarction, in which ischemic stroke occurs during an attack of MWA and migraine-related stroke, in which the causal link is less clear. Migrainous infarction accounts for only one-third of migraine-stroke, strokes may occur during attacks of MwoA, and a number of cerebrovascular disorders may present as MWA or MwoA. Migraine may occur as a consequence of conditions that are known to cause stroke; therefore it remains to be determined whether migraine predisposes to stroke in the absence of any known disease associations, if it is an epiphenomenon of an underlying stroke diathesis, or if it requires the presence of another stroke risk factor to produce cerebral ischemia. Furthermore, it is unclear if ischemia results in migraine more often than migraine results in ischemia. Careful clinical studies that evaluate this bidirectional relationship are needed to determine why migraine patients are subject to a higher risk of ischemic stroke.
Insights
Migraine, particularly migraine with aura, is linked to a higher risk of ischemic stroke. Further research is needed to understand the complex relationship between migraine and stroke causation.
Area of Science:
- Neurology
- Cerebrovascular Diseases
- Epidemiology
Background:
- Population and case-control studies show a significant association between migraine and ischemic stroke.
- The risk of ischemic stroke is notably higher in individuals with migraine with aura (MWA) compared to migraine without aura (MwoA).
Purpose of the Study:
- To elucidate the complex relationship between migraine and ischemic stroke.
- To determine if migraine predisposes to stroke independently, is a consequence of underlying conditions, or requires other risk factors.
- To investigate the bidirectional causality between migraine and ischemic stroke.
Main Methods:
- Review of existing population and case-control studies on migraine and stroke.
- Analysis of distinct migraine-stroke entities, including migrainous infarction and migraine-related stroke.
- Identification of cerebrovascular disorders that may present with migraine symptoms.
Main Results:
- Migrainous infarction, occurring during MWA attacks, accounts for one-third of migraine-stroke cases.
- Strokes can also occur during migraine without aura (MwoA) attacks.
- Various cerebrovascular disorders can manifest as MWA or MwoA.
Conclusions:
- The exact causal link between migraine and ischemic stroke remains unclear.
- It is undetermined whether migraine is a primary cause of stroke, an epiphenomenon, or requires co-existing risk factors.
- Further clinical studies are essential to understand the bidirectional relationship and elevated stroke risk in migraine patients.
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