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Abstract
Migraine and stroke are highly prevalent diseases with a high effect on quality of life, with multiple epidemiologic, pathophysiologic, clinical, and prognostic areas of overlap. Migraine is a risk factor for stroke. This risk is explained by common risk factors, migraine-specific mechanisms, and non–migraine-specific mechanisms that have a relevant role in patients with migraine with aura (e.g., atrial fibrillation and paradoxical embolism through a patent foramen ovale). Another important link between migraine aura and ischemic stroke is cardiac embolism. Cardioembolism is the most frequent cause of ischemic stroke, and increasing evidence suggests that microembolism, predominantly but not exclusively originating in the heart, is a contributing mechanism to the development of migraine aura. In this review, we discuss epidemiologic aspects of the association between migraine and ischemic stroke, the clinical presentation of ischemic strokes in patients with migraine, and the differentiation between migrainous and nonmigrainous infarctions. After that, we review migraine-specific and non–migraine-specific stroke mechanisms. We then review updated preclinical and clinical data on microembolism as a cause of migraine aura. In the last section, we summarize knowledge gaps and important areas to explore in future research. The review includes a clinical vignette with a discussion of the most relevant topics addressed.
Glossary
- 5HT=
- serotonin;
- CADASIL=
- cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy;
- CBF=
- cerebral blood flow;
- FHM=
- familial hemiplegic migraine;
- fMRI-BOLD=
- functional MRI–bold oxygen level dependent;
- ICHD-3=
- International Classification of Headache Disorders, Third Edition;
- MA=
- migraine with aura;
- MELAS=
- mitochondrial encephalopathy with lactic acidosis and stroke-like episode;
- MO=
- migraine without aura;
- OR=
- odds ratio;
- PFO=
- patent foramen ovale;
- SD=
- spreading depression
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Solicited and externally peer reviewed. The handling editor was Associate Editor Rebecca Burch, MD.
- Received June 13, 2022.
- Accepted in final form November 1, 2022.
- © 2022 American Academy of Neurology
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