Stroke and Migraine

Introduction

Migraine headache is both a prevalent and potentially debilitating condition attributed to both environmental and hereditary factors. It is associated with significant comorbidities including depression, dysautonomia, cognitive dysfunction, vertigo, and stroke. Migraine accounts for approximately one-third of neurologic disease burden in daily adjusted life years and ranked in the top 30 (of 176) of the highest burdens of disease in most areas of the world . Much has been learned about the pathophysiology of migraine in the last 20 years that can shed light on its association with stroke. In this chapter, we review the current data, summarize the proposed causality, and discuss the clinical pearls that both relate and distinguish migraine and stroke.

What Is Migraine?

Migraine headache is primarily a neuronal disorder with subsequent secondary vasomotor effects on intracranial and extracranial cerebral blood vessels. It may be acute and intermittent, or it may become a chronic, daily disabling condition. Migraine is three times more prevalent in women than in men and, in about a third of people, can be accompanied by a visual or sensory aura . An episode, which may last typically from 4 up to 72 hours, can potentially be intractable and lead to hospitalization. A diagnosis of migraine is characterized by the presence of at least two of four characteristics, including (1) throbbing character, (2) unilaterality, (3) potential of becoming severe, and (4) worsening with physical exertion, and at least one of the two autonomic components including (1) nausea/vomiting/anorexia or (2) sensitivity to light, sound, touch, and smell.

What Is the Relationship of Migraine to Stroke?