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Hypercoagulability and Migraine.

Gretchen E Tietjen1, Stuart A Collins1

  • 1Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.

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PubMed
Summary
This summary is machine-generated.

Migraine with aura may increase ischemic stroke risk due to hypercoagulability, not atherosclerosis. Evaluation for thrombophilia is recommended for those with a history of thrombosis or stroke indicators.

Keywords:
aurahypercoagulabilitymigrainepolymorphismsstroke

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Area of Science:

  • Neurology
  • Hematology
  • Vascular Medicine

Background:

  • Migraine with aura is linked to increased ischemic stroke risk, independent of atherosclerosis.
  • Hypercoagulability is a potential mechanism connecting migraine with aura to stroke.
  • Cortical spreading depression theory suggests micro-emboli trigger aura or transient ischemic attacks.

Purpose of the Study:

  • To review literature on the association between migraine and thrombophilic states.
  • To investigate links with acquired/inheritable conditions, estrogen levels, endothelial dysfunction, and genetic factors.

Main Methods:

  • Literature review and meta-analysis of studies on migraine and thrombophilia.
  • Analysis of associations with specific thrombotic markers and genetic polymorphisms.
  • Examination of patent foramen ovale (PFO) in relation to migraine and stroke.

Main Results:

  • Evidence links migraine, especially with aura, to elevated estradiol, thrombo- and erythrocytosis, von Willebrand factor (vWF), fibrinogen, tissue plasminogen activator (tPA), and endothelial microparticles.
  • Conflicting results exist for antiphospholipid antibodies (aPL), homocysteine, Protein S, and MTHFR C677T polymorphism.
  • Migraine with aura is associated with thrombophilia and PFO in young stroke patients; PFO association with migraine with aura is supported by meta-analyses but not all population studies.

Conclusions:

  • Hypercoagulability evaluation is warranted for migraine with aura patients with thrombosis history or stroke indicators.
  • Screening for endothelial activation markers may be considered for migraine with aura alone.
  • Management of stroke risk factors is crucial; anti-thrombotic efficacy in migraine is unproven, and PFO closure is not routinely recommended.