
Migraines, especially in women, are associated with a higher risk of stroke. This risk is doubled in women with migraine with aura, a variation of the disorder where the headache is accompanied by sensory disturbances, such as flashes of light, zigzag lines, and tingling sensations. While the link between migraines and strokes is not fully understood, it is believed to be related to spasms in the arteries and an increased risk of blood clots, which can lead to ischemic strokes when blood vessels to the brain are blocked. Although the risk is relatively low, it is important for individuals with migraines, especially those with aura, to be aware of the potential connection and take steps to manage other risk factors for stroke, such as high blood pressure and cholesterol levels.
Characteristics | Values |
---|---|
Migraine with aura | Increased risk of ischaemic stroke |
Migraine without aura | Not significantly associated with ischaemic stroke |
Migraine with aura and oral contraceptive use | Increased risk of blood clots |
Migraine with aura and age | Women aged 45 and younger are at greater risk of migrainous strokes |
Migraine with aura and age | In older people, migraine is not a risk factor for stroke unless they are smokers or if migraine started later in life |
Migraine with aura and gender | Women are at greater risk of stroke |
Migraine with aura and gender | Migraine with aura is associated with a doubling of risk for women |
Migrainous infarction | Prolonged aura symptoms lasting longer than 60 minutes |
Migrainous infarction | Typical aura symptoms for the individual |
Migrainous infarction | Brain scan showing signs of damage, with no other cause |
Migraine with aura and stroke | Migraine with visual aura was linked to an increased risk of cardioembolic stroke |
What You'll Learn
Migraines and stroke risk factors
Migraines are recurring, throbbing headaches that can cause nausea and weakness. A migraine with aura is a variation of the disorder that involves sensory disturbances such as flashes of light, zigzag lines, tingling sensations, and difficulty speaking. While migraines themselves do not cause strokes, studies have shown that there is a link between migraines and increased stroke risk, particularly in women. This is what is known as a migrainous stroke or migrainous infarction.
According to the American Migraine Foundation, only 2,000-3,000 out of 800,000 strokes suffered each year in the United States are linked to migraines. However, this link is thought to be related to the arteries. Dr Karen Furie, chair of the department of neurology at Brown University Medical School, explains that migraines involve a spasm in the artery, and when combined with oral contraceptives, which increase the risk of blood clots, problems can develop. This combination may increase the likelihood of clot formation, which can lead to a stroke.
Research has shown that there is an increased risk of ischaemic stroke in people with migraine with aura compared to those without migraine. Ischaemic strokes are caused by a blocked blood supply to the brain and are responsible for most cases of stroke. Women aged 45 and under with migraine with aura are at a greater risk of migrainous strokes due to hormonal changes and increased risk of blood clots from hormonal birth control. Additionally, the risk of ischaemic stroke is higher in women who smoke and those who use oral contraceptives.
While the connection between migraine and stroke is not yet fully understood, it is important to manage vascular risk factors such as high blood pressure and high cholesterol to lower the risk of stroke. For people experiencing symptoms of a stroke, it is crucial to seek emergency medical care to prevent life-threatening complications and promote recovery.
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Migraines with aura and ischaemic strokes
Aura is a set of symptoms preceding a migraine, such as flashes of light, zigzag lines, or tingling in the face or hands. Migraines with aura are likely caused by a specific neurophysiological phenomenon called cortical spreading depression, which involves a slow-spreading wave of cortical electrical discharges and hyperperfusion, followed by hypoperfusion. Migraines with aura can also be associated with increased levels of the neuropeptide calcitonin gene-related peptide (CGRP), which may trigger coronary blood flow/velocity changes and increase the risk of atrial fibrillation in patients with recurrent migraines.
Women, especially those aged 45 and younger, appear to be at a greater risk of migrainous strokes. This may be due to hormonal changes and the increased risk of blood clots due to hormonal birth control. Migraine with aura is also associated with an increased risk of cardioembolic stroke, possibly due to undiagnosed paroxysmal atrial fibrillation or patent foramen ovale (PFO).
While the link between migraines with aura and ischaemic strokes is recognised, migrainous strokes are rare, accounting for only about 0.8% of all strokes. The connection between migraine and stroke is not yet fully understood, and more research is needed to elucidate the physiological mechanisms underlying the migraine-stroke association.
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Migraines without aura and ischaemic strokes
The link between migraines and strokes likely runs through the arteries. Migraines involve a spasm in the artery, and when this is combined with oral contraceptives, which can increase the risk of blood clots, problems can develop. If the vessel constricts, the blood flow reduces, and if you are on hormones that increase the risk of clotting, a clot may form and cause a stroke.
The occurrence of migrainous strokes is rare and accounts for only 0.8% of all strokes. However, research has shown an increased risk of stroke in patients with a history of migraines with aura. Women aged 45 and younger appear to be at greater risk, possibly due to hormonal changes and increased risk of blood clots due to hormonal birth control.
To lower the risk of migrainous strokes, patients can make lifestyle changes such as controlling high blood pressure and lowering high cholesterol. The treatment for migrainous strokes is the same as for ischemic strokes without migraine with aura.
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Migraines and haemorrhagic strokes
Overview
Migraines are a leading cause of disabilities worldwide, and strokes are the second leading cause of death globally. While migraines do not cause strokes, they are associated with an increased risk of stroke. This relationship is complex and not yet fully understood. However, it is believed that vascular mechanisms, such as vasospasm, endothelial and platelet dysfunction, and alteration in the vessel wall may play a role. Additionally, shared risk factors, such as oral contraceptive use, smoking, and vascular pathologies, may also contribute to the association between migraines and strokes.
Haemorrhagic strokes occur when weakened blood vessels that supply the brain burst. While the relationship between migraines and haemorrhagic strokes is unclear, some studies have found a link between the two. One study reported an increased risk of developing a haemorrhagic stroke in patients with migraines, with a hazard ratio of 2.22 compared to those without migraines. However, another study found no association between migraines without aura and haemorrhagic strokes.
It is important to note that the overall risk of stroke associated with migraines is still considered low. People with migraines are generally younger, and this group tends to have a lower risk of stroke. Additionally, the occurrence of migraines often declines as people get older, while strokes are more frequent in older individuals.
Risk Factors and Management
Several risk factors may increase the likelihood of experiencing a haemorrhagic stroke in individuals with migraines. These include:
- Oral contraceptive use: Women who use oral contraceptives and have migraines, especially with aura, are at an increased risk of stroke. It is recommended that women with migraines, particularly those with aura, carefully discuss oral contraceptive options with their healthcare providers.
- Smoking: Smoking is a risk factor for both migraines and strokes, and it can increase the likelihood of experiencing a stroke in individuals with migraines. Quitting smoking can help reduce this risk.
- Vascular pathologies: Conditions such as platelet dysfunction, hypertension, and high cholesterol profiles are risk factors for both migraines and haemorrhagic strokes. Managing these vascular risk factors can help lower the risk of stroke in individuals with migraines.
- Patent foramen ovale (PFO): The presence of PFO, a condition where blood bypasses the pulmonary circulation, is associated with an increased risk of stroke and a higher prevalence of migraines. However, there is limited evidence to support migraine relief from PFO closure.
- Migraine treatments: Certain migraine medications, such as ergotamine, can cause arterial vasoconstriction and increase the risk of cerebral ischemic episodes. Modern migraine pharmacotherapeutic agents, such as fremanezumab and galcanezumab, may be safer alternatives for individuals with a high cardiovascular risk profile.
While the relationship between migraines and haemorrhagic strokes is not yet fully understood, there is an increased risk of haemorrhagic stroke in individuals with migraines, particularly in those with specific risk factors. It is important for individuals with migraines to be aware of these risk factors and work with their healthcare providers to manage them effectively.
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Migraines and TIAs (transient ischaemic attacks)
Transient ischaemic attacks (TIAs) are temporary focal neurological symptoms resulting from cerebral, retinal, or spinal ischaemia. The concept of TIAs emerged in the 1950s when it was observed that ischaemic stroke often followed transient neurological symptoms in the same arterial territory. TIAs are due to locally decreased blood flow to the brain, causing focal neurological symptoms.
Migraines are recurring, throbbing headaches that can be debilitating and are often accompanied by nausea and weakness. A migraine with aura is a particularly alarming variation where the headache is accompanied by sensory disturbances ranging from seeing flashes of light to tingling sensations and difficulty speaking. Migraines with aura have been linked to a higher risk of stroke, especially in women.
The connection between migraines and TIAs is not yet fully understood, but research has shown an increased risk of stroke in patients with a history of migraines with aura. Migraine headaches usually affect only one side of the head and are often accompanied by nausea, vomiting, and extreme sensitivity to light or sound. In some patients, the pain may switch sides with each migraine.
For a stroke to be classified as a migrainous stroke, it must occur alongside a migraine with aura. Migrainous strokes are rare and account for only 0.8% of all strokes. However, the occurrence of a migrainous stroke can be predicted by the presence of specific warning signs such as a previous headache that worsens or a new type of headache.
The pathophysiological differences between TIAs and migraines mean that careful consideration of clinical features can be helpful in establishing the correct diagnosis. While TIAs usually present with negative symptoms such as numbness, weakness, or visual loss, migraine auras typically start as positive symptoms such as flashing lights or zigzag shapes. Additionally, TIAs usually last less than an hour, while migraine auras can persist for many hours.
In summary, while the exact link between migraines and TIAs is still being investigated, it is clear that there is an increased risk of stroke in patients with migraines, especially those with aura. The presence of specific warning signs such as a worsening headache or new type of headache can indicate an impending TIA, and prompt diagnosis and treatment are critical to prevent life-threatening complications.
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Frequently asked questions
Migraines are recurring, throbbing headaches that can cause nausea, weakness and sensitivity to light or sound.
A stroke is a serious medical condition that occurs when the blood supply to the brain is cut off, causing brain cells to die.
Studies have shown that there is an increased risk of ischaemic stroke in people with migraines with aura, compared to people without migraines. However, the connection between migraine and stroke is not yet fully understood.
Risk factors for stroke in people with migraines include age, hormonal changes, hormonal birth control, smoking and a history of migraines with aura.