The association between migraine and cerebral vascular events: an analytical review

This paper explores the uncertain relationship between migraine headache and thromboembolic stroke. In reviewing the literature that links migraine with thromboembolic cerebral vascular events, a distinction is made between two stroke events that occur in migraine patients: stroke associated with a migraine attack (a migrainous stroke) and stroke unrelated to a migraine attack (a non-migrainous stroke). In a recent community-based stroke register, migrainous strokes occurred at a rate of 3.4 per 100,000 per annum. Prevalence rates for migraine in young stroke populations (11-28%) are similar to those in the general population and do not support an additional long-term risk of non-migrainous stroke in migraine patients. The only study providing a controlled estimate of long-term thromboembolic stroke risk (odds ratio = 1.7; 95% CI 1.3, 2.2) included only women and has not been independently confirmed. The contribution of migraine to other known risk factors for thromboembolic stroke needs to be examined further by controlled studies.