Migraine and Vascular Disease

European Neurological Review, 2009;4(2):92-94 DOI: http://doi.org/10.17925/ENR.2009.04.02.92


Migraine is a common disease that is considered to be a benign disorder. However, recently evidence was produced that migraineurs, especially those with aura, have an increased risk of stroke and cardiac disease. These patients have more cardiovascular risk factors, but migraine seems to bear a risk in itself. The pathophysiology is still unknown. Patients might have endothelial dysfunction, which is associated with an increased risk of stroke and cardiac events. Other potential mechanisms include coagulation abnormalities and platelet hyperaggregability. A patent foramen ovale (PFO) that might lead to cardiac embolism is more often observed in migraineurs than in people without migraine. It is not yet known whether the disorders are genetically linked or whether a PFO is a risk factor for migraine with aura. This review examines the occurrence of stroke and cardiac events in migraineurs and discusses potential mechanisms.
Keywords: Migraine, aura, stroke, endothelial dysfunction, patent foramen ovale, myocardial infarction
Disclosure: Kasja Rabe has no conflicts of interest to declare. Zaza Katsarava has received research grants and honoraria from Allergan and Bayer, and is an advisory board member for Allergan. Headache research at the Department of Neurology in Essen is supported by the German Research Council (DFG), the German Ministry of Education and Research (BMBF) and the EU.
Received: February 05, 2009 Accepted August 03, 2009
Correspondence: Kasja Rabe, Department of Neurology, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany. E: kasja.rabe@uni-due.de

Migraine is a common primary headache disorder with a lifetime prevalence of up to 33% in women and 13.3% in men.1 Almost one-third of migraineurs experience transient neurological (visual, aphasic, sensory and motor) symptoms known as aura before onset of headache. Although migraine is known to be a benign disorder, migraine and stroke have been linked for many years.2 Additionally, recent trials have demonstrated a higher occurrence of cardiovascular diseases in migraineurs.3–6 People with migraine with aura seem to have an increased risk of cardiovascular events than migraineurs without aura, although the data are inconclusive and the underlying pathophysiology is not clear. This article summarises the recent literature connecting migraine to cerebrovascular and cardiovascular disorders.

Migraine and Stroke

People with migraine, especially those with migraine with aura, have a higher risk of stroke than adults without headache.7–10 The increased risk is more evident in younger people6,8,10,11 and in migraine with frequent attacks.12 In a meta-analysis of observational studies published between 1966 and 2004, Etminan et al.10 found an increased relative risk (RR) of ischaemic stroke of 2.16 (95% confidence interval [CI] 1.89–2.48) in migraineurs. The risk of stroke was further increased in women under 45 years of age (RR 2.76, 95% CI 2.17–3.52). In 2005, Kurth et al.8 published a prospective cohort study using data from the Women’s Health Study. In this trial, 39,754 healthy women 45 years of age or older were followed for an average of nine years. Women with migraine with aura who were between 45 and 55 years of age had an increased risk of stroke (RR 2.25, 95% CI 1.30–3.91). Women with migraine without aura were not at greater risk than people without headache. To assess the risk of stroke in men, Kurth analysed data from the Physicians’ Health Study, which included 20,084 men.6 In contrast to what was observed in women, migraineurs did not have an increased risk of stroke compared with men without headache.

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Keywords: Migraine, aura, stroke, endothelial dysfunction, patent foramen ovale, myocardial infarction