Ischemia-induced migraine from paradoxical cardioembolic stroke

Although little is known on the pathophysiologic mechanism of migraine-related stroke, the prevailing attitude is that vasoconstriction and activation of clotting factors play a primary role. In 2 female patients presenting with migraine and stroke, risk profiles and history were consistent with this pathophysiologic mechanism. Cerebro- and cardiovascular workup, however, led to a diagnosis of paradoxical cardioembolic stroke through a patent foramen ovale. Since there is hardly any evidence in the literature that migraine acts as a risk factor for stroke on its own, these case reports emphasize the importance of complete cardiovascular evaluation in patients with suspected migrainous stroke.