Migraine and Stroke

Abstract

Headache is a common symptom of stroke, and primary headaches occur as a common comorbidity. Migraine is a primary headache that mainly affects younger women and whose prevalence increases up until the age of 50. The likelihood of developing an ischemic stroke is higher in younger women who suffer from migraines with aura. Genetics also plays an important role in the pathophysiology of migraine and stroke, primarily encoding proteins that regulate vascular endothelial function and the production of blood clotting factors. Risk factors include obesity, hyperlipidemia, hyperglycemia and smoking, as well as the use of oral contraceptives. Some cardiac factors, such as persistent foramen ovale, increase the risk of developing migraine with aura and cerebrovascular disease. How all these factors affect the very pathophysiology of migraine and cerebrovascular disease is still the subject of research. There are indications that hemorrhagic stroke is also more common in younger women with migraine, although research is still contradictory. What is evident, however, is that women who have a migraine with aura, and suffer a form of hemorrhagic stroke, are also more likely to have a worse outcome in terms of mortality or significant disability. Migraines are more common in some other cerebrovascular diseases such as dissection of the cervical arteries, and in cerebral small blood vessel diseases, where genetic changes are of major influence. The presence of vascular disease limits the use of acute and prophylactic migraine therapy due to its vasoconstrictive effect. Measures to prevent stroke in migraine patients are aimed at controlling risk factors.