Migraine and stroke can have similar symptoms, especially migraine variants such as basilar migraine, ocular migraine and others. About one-third of migraineurs experience auras including speech, sensory, visual or motor symptoms, which can mimic many common stroke-like symptoms. It is best described as a moderate to severe throbbing headache lasting 4–72 hours and is often associated with nausea, vomiting, photophobia and phonophobia. Migraine is one of the most common neurological disorders, affecting 11%–15% of the population. Hopefully, with the advance of genetic research, genome-wide screening and knowledge for specific diseases, such as cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and others, one will be able to use individualised prophylaxis and treatment for patients and begin the era of precision medicine.Ĭlinical presentation of migraine and stroke In this review, we will discuss epidemiology, possible mechanisms, advanced genetic findings and clinical management of this complex situation. However, these two conditions are known to have in common the following: (1) pathogenesis, (2) risk factors and (3) clinical and imaging manifestation. The association between ischaemic stroke and migraine with aura, especially in younger (age ≤45 years) women, is already established and well accepted, 5–8 but there is still uncertainty with respect to its mechanisms, correlation between stroke and migraine without aura, management, prophylaxis in clinical practice and so on. 2 3 Though migraine is generally considered a benign disease that affects 11.7% of the US population (17.1% of women and 5.6% of men), 4 there is unequivocal evidence showing association between migraine and stroke. 1 In the USA, stroke is the fifth leading cause of death and approximately 8 00 000 people have a stroke each year. Based on data from the Global Burden of Disease Study 2013, more than 10 million people suffer an acute stroke (ischaemic or haemorrhagic) each year, which represents a global incidence of 175.4/100 000/year.

With the increase in both size and age of the world population, stroke has become one of the heaviest global health burdens, especially in middle-income to low-income countries. Further studies will determine if more aggressive treatment of migraines can ultimately lead to fewer strokes in this population. In treating patients with migraines, it is important to identify and modify any vascular risk factors such as hypertension, smoking, oral contraceptive pill use and lifestyle factors. These may be caused in part by alterations in resting cerebral blood flow and vasoconstrictor use. On imaging, many migraineurs are found to have white matter changes similar to those seen in patients with stroke.

There are also some rare genetic diseases such as cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy, retinal vasculopathy with cerebral leukodystrophy and others, which can cause both migraines and infarcts. Migraine is also shown to be correlated to haemorrhagic stroke, although studies do not demonstrate causation versus association, and further studies are warranted. Vasoconstrictors such as the triptan and ergot class are commonly used to treat migraines and may also play a role. Other factors contributing to migrainous infarct may include vascular, inflammatory, endothelial structure, patent foramen ovale, gender, oral contraceptive pill use and smoking. The exact pathogenesis of migrainous infarct is not known, but it is theorised that the duration and local neuronal energy level from cortical spreading depression may be a key factor. Patients can also suffer from migrainous infarction, a subset of ischaemic stroke that often occurs in the posterior circulation of younger women. However, research has shown an association between migraines and stroke, and especially between migraine with aura and ischaemic stroke. Migraines are generally considered a relatively benign neurological condition.

Migraine with aura stroke