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When migraine mimics stroke: A systematic review.

Alberto Terrin1, Giulia Toldo1, Mario Ermani1

  • 11 Headache Centre, Department of Neuroscience, University of Padova, Padova, Italy.

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Migraine with aura is a common stroke mimic, leading to nearly 18% of incorrect thrombolytic treatments. While seemingly risky, thrombolysis for migraine with aura appears to have a very low adverse event rate.

Keywords:
Headacheauraoutcomesafetythrombolysis

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Clinical Research

Background:

  • Migraine with aura can present symptoms similar to acute ischemic stroke.
  • Misdiagnosis can lead to inappropriate thrombolytic treatment in migraine patients, risking adverse effects.

Purpose of the Study:

  • To systematically review and quantify the prevalence of migraine with aura among stroke mimics.
  • To assess the safety of thrombolytic therapy in patients experiencing migraine with aura.

Main Methods:

  • Systematic literature review of studies published after 1995.
  • Categorization of studies based on whether stroke mimics received systemic thrombolysis.
  • Analysis of the incidence of migraine with aura in stroke mimic populations and its contribution to thrombolysis administration.

Main Results:

  • Migraine with aura constitutes 1.79% of emergency stroke unit evaluations and 12.24% of non-thrombolysis-treated stroke mimics.
  • Approximately 6.65% of systemic thrombolysis is administered to patients without acute ischemic stroke, with migraine with aura accounting for 17.91% of these cases.
  • The reported rate of adverse events associated with thrombolysis in this group is notably low at 0.01%.

Conclusions:

  • Migraine with aura is the third most frequent stroke mimic, contributing significantly to unnecessary thrombolytic treatments.
  • Despite limited supporting data, thrombolysis for migraine with aura appears to carry an extremely low risk of adverse events.