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 occurrenceof 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 articlesummarises 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 people^6,8,10,11 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 strokewas 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 wasobserved in women, migraineurs did not have an increased risk of stroke compared with men without headache. Another prospective trial included 12,750 men and women 55 years of age or older from the Atherosclerosis Risk in Communities Study.⁹ Men and women with migraine with aura had an increased risk of stroke compared with people without headaches or migraineurs without aura (RR 2.91, 95% CI 1.39–6.11). Even after adjusting for risk factors, migraineurs had a higher risk of stroke. The Stroke Prevention in Young Women Study12 included 386 women 15–49 years of age witha first ischaemic stroke. Participants with migraine with aura (visual symptoms) had an increased risk of ischaemic stroke comparedwith participants without headache (odds ratio [OR] 1.5, 95% CI 1.1–2.0). The risk further increased if attacks occurred at least once a month on average.

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