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Can Migraines Lead To Stroke

How Are They Linked

Does migraine cause stroke? | Norton Neuroscience Institute

Some ocular migraine symptoms, such as vision loss or disturbance in one or both eyes, can be the same or very similar to stroke symptoms. Also, some who suffer from migraine with aura symptoms may have stroke-like symptoms, such as motor skill issues, speech difficulties, or other sensory difficulties.

A migraine with aura can also resemble a transient ischemic attack , also known as a ministroke. A stroke headache can also be similar to a migraine headache.

It’s difficult to determine the cause of many headache symptoms without diagnostic imaging. On diagnostic imaging, white matter changes have been found in some people with migraines that appear similar to stroke patients.

Migraine Drugs And Risk Of Stroke

Triptans and ergot alkaloids, two effective acute migraine treatments, have vasoconstrictive properties that may potentially increase the risk of serious ischaemic vascular events, including stroke. Available data link ergotamine overuse with increased risk of cardiovascular and cerebral ischaemic events, particularly in patients with pre-existing cardiovascular disorders who overused the drug. While there is no evidence to support cardiovascular safety issues for triptans, even not in patients with overuse, caution must be exercised when considering the use of triptans in patients with risk factors for cardiovascular disease and especially in those with established CV disease. It should be noted that the association between migraine and stroke is mainly driven by MA, while migraine specific drugs are used by people with migraine regardless of aura status. For these reasons, use of migraine specific drugs is unlikely to explain the increased stroke risk in migraine.

Clinical implication

Migraine Abortive Drugs And The Risk Of Stroke

Acute abortive medications for migraine attacks have vasocontrictive actions. Thus, some clinicians too much concern of cerebral vasospasm and consequent stroke when prescribing these agents. However, stroke rarely occurs in migraine patients who do not abuse ergots or triptans in the absence of contraindication.

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Aura: Warning Sign Of A Migraineand A Future Stroke

Excruciating pain. Nausea. Sensitivity to light. The crushing symptoms of migraine headaches affect 15% of the population and, unfortunately, women are 3 times as likely as men to experience them.

Migraine headaches alone are bad enough. But add the symptoms related to auras and your risk of a future stroke goes up significantly.

AURA

A migraine headache with aura, known as a classical migraine, affects up to 30% of migraine sufferers. Five to 20 minutes before the onset of the headache, you see flashing lights, sparks, and dark patches. These effects might be accompanied by the feeling of pins and needles, spreading from one part of your body to another.

In some ways the aura is a good thing. Longtime sufferers recognize the aura as a warning sign of an oncoming migraine. It allows the victim to prepare, taking medication to reduce the severity of the migraine.

The migraine with aura should also be seen as a warning sign of possible stroke and heart problems.

WHAT IS THE RISK?

First, the good news: In most people, migraines rarely result in a stroke. Evidence says its also unlikely that a stroke will occur during a migraine.

The not-so-good news: People who suffer migraines are more likely to eventually have some type of heart or vascular problem. A cause-and-effect hasnt been proven. In other words, the migraine with aura doesnt CAUSE the stroke. But the two do occur together.

WHAT YOU CAN DO

Connections Between Migraine And Stroke

Migraine sufferers who see lights and blind spots are at ...

Migraine with Aura is a risk factor for stroke, particularly for women, even those younger than 45 or even 35, Tietjen said. People who experience aura might have increased tendency to form blood clots due to temporarily narrowed blood vessels, which can predispose them to stroke, Tietjen said, which studies suggest may increase stroke risk compared to women in that age group who dont have migraines.

These are people that otherwise, if they didnt have migraine, might not be at risk, Tietjen said. You dont expect young women to suffer a strokes. The absolute risk is small, though, Tietjen said: There are about 800,000 strokes a year, half of them among women, and 2,000 to 3,000 might be related to migraine. Still, I dont think its something that should be discounted just because the numbers arent high, she said.

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Stroke Or Migraine The Migraine

Migraine is the most common neurological disorder, affecting 10% to 15% of adults in the U.S. According to a study published in the Journal of Stroke, people who suffer from migraine headaches have increased risks for a variety of vascular diseases, including ischemic stroke and hemorrhagic stroke.

TheNational Headache Foundation reported that people who have migraine with aura are more than twice as likely to have an ischemic stroke as people who have migraine without aura. In addition to a severe headache, it is these aura symptoms that can mimic some of the signs of a stroke or transient ischemic stroke .

Migraine With Aura Linked To Clot

People who have migraines with aura are more likely to have strokes caused by either a blood clot in the heart or a clot within the brains blood vessels , compared to those that dont have migraines with aura, according to research presented at the American Stroke Associations International Stroke Conference 2016.

Some people with migraines experience neurological symptoms such as flashes of light, blind spots, or tingling in the hand or face. In adults, symptoms usually happen before the headache itself. Migraines with aura account for less than 20 percent of all migraines, researchers said.

In a 25-year ongoing study of 12,844 adults in four U.S. communities, 817 participants were identified as having an ischemic strokes .

When they compared migraine with aura patients to those who had migraine without aura, researchers found:

  • Overall, migraine with aura patients were 2.4 times more likely to have an ischemic stroke.
  • Migraine with aura patients were three times more likely to have an ischemic stroke caused by a mass or a clot that forms in the heart, dislodges and travels to the brain .
  • Migraine with aura patients were twice as likely to have an ischemic stroke caused by a clot that develops in a clogged part of the blood vessel supplying blood to the brain .
  • There was no significant association between migraine with aura and ischemic stroke caused by blockage of small arteries that supply blood to deep brain structures .

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Migraine And Risk Of Cardiovascular Disease

There is growing evidence of an association between migraine and other cardiovascular disorders including myocardial infarction, hypertension, venous thromboembolism and atrial fibrillation , with stronger association in people with MA. An association between migraine and cardiovascular disease mortality has also been found. While the annual cardiovascular mortality risk for migraine is relatively low, the risk may accumulate when magnified across decades of individual migraine exposure. The QRISK3 algorithm was recently developed and validated to predict 10-year risk of cardiovascular disease in men and women aged 2584 years. Migraine being included in this algorithm indicates its importance in the risk prediction of cardiovascular disease. Although evidence for a link between migraine and cardiovascular disease exist, it is still unclear whether migraine itself increases the risk or is a marker of another underlying cause. Improvement of aura with aspirin and migraine with warfarin has been observed in observational case studies however, further research is necessary to confirm these effects. There is no evidence that controlling migraine attacks with preventive drugs can reduce cardiovascular risk.

Clinical implication

Current migraine guidelines do not recommend use of antithrombotic drugs in the prophylaxis of migraine, but clinicians should consider whether patients at particularly high risk of cardiovascular disease would benefit from such treatment.

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Headaches after stroke

New Harvard research confirms some links, rejects others.

Two new studies from Harvard examine the possible associations between migraine headaches and other conditions. One study offers encouraging news: the headaches will not hurt thinking skills. Another study suggests a warning: the headaches, when accompanied by aura, may signal an increased risk of heart attacks and stroke. “After high blood pressure, migraine with aura was the second strongest single contributor to the risk of heart attacks and strokes,” says study author Dr. Tobias Kurth, adjunct associate professor of epidemiology at the Harvard School of Public Health. “It was followed by diabetes, family history, smoking, and obesity.”

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Cerebrovascular Events Triggering A Migraine

The association between migraine and stroke is complicated by the fact that almost any cerebrovascular event can trigger a migraine-like attack , which may lead to misinterpretation of the stroke event as complicated migraine. The increased frequency of migraine aura in later life may be the symptomatic expression of an underlying stroke risk factor rather than the aura itself increasing the risk of stroke. Most studies, particularly prospective studies, collect information on migraine status before the vascular event, and thus is not the mechanism behind the migraine-stroke association.

What Can Trigger A Migraine

For many migraine sufferers, symptoms are often triggered by various stimuli or situations. These triggers can vary among migraineurs, but there are many common culprits.

Women between the ages of 20 and 45 are the demographic most likely to suffer from migraines, and women overall arethree times more likely to experience migraine headaches than men. This discrepancy between the sexes was once erroneously attributed to a perceived inability of women to cope with stress. Interestingly enough, in youth, boys are actually more likely to experience migraines than young girls. However, per theNashville Neuroscience Group, once menstruation begins, the fluctuation of hormones in women causes asubstantial increase in migraines. Stress can also play a substantial part in triggering symptoms in a recent study, nearly 60 percent of participants listed stress as aprecipitating influence.

Other common migraine triggers are diet-related and may be avoided by employing restrictions. Migraines are routinely reported to betriggered by dairy, alcohol, chocolate, citrus fruits, and nuts, as well as by fasting. Certain types ofodors may trigger migraines for some sufferers.Meteorological triggers related to low temperature, relative humidity, and atmospheric pressure are also important to note, although these stimuli are less frequently reported as triggers than the aforementioned factors.

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Ocular Migraines And Stroke

Henry HoffmanThursday, September 27th, 2018

Today, migraines are considered the most common neurological disorder according to the Journal of Stroke, and, in the United States alone, about30 million people suffer from these debilitating headaches. Research has determined that all migraineurs are at a higher risk of suffering a stroke, and this risk factor is potentiallydoubled or tripled for individuals who suffer from migraines with visual disturbances collectively known as aura.

Unfortunately, migraines with aura exhibit similar symptoms to those associated with certain life-threatening conditions, namelytransient ischemic attacks and strokes. For this reason, many migraineurs may mistake early stroke warning signs for classic migraine symptoms. Telling the difference and recognizing a medical emergency for what it is can be difficult, but isnt impossible.

Migraine Stroke And Special Concerns In Women

YOUR GUIDE TO UNDERSTANDING STROKE  Multispeciality ...

Migraine is a predominantly female disorder, affecting women with a ratio of approximately 3:1 to men. The highest 1-year prevalence of migraine is between ages of 25 and 55 years, and it is estimated that 22%37% of women will experience migraine during their reproductive years. As the association between migraine and ischaemic stroke is particularly strong in women with MA under the age of 45, certain aspects during a womans life need to be considered.

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Relationship Between Migraine And Other Underlying Diseases

Migraine is one of the common disorders that can happen to anyone. It disproportionately affects the women population more than men. It has been implicated that people with migraine are at higher risk of getting diagnosed with cardiovascular diseases. Migraine with aura increases the risk factors of cardiovascular mortality. However, the relationship between cardiovascular diseases and migraine is still under research or confusing

People who suffer from migraine with aura are probably at higher risk of getting affected by any underlying disease like heart disease and stroke. They are more likely to die with such medical conditions.

Migraine And Hemorrhagic Stroke

In addition to higher risk of ischemic stroke, migraineurs also have a risk for developing hemorrhagic stroke. Womens Health Study demonstrated increased risk for hemorrhagic stroke in women with active migraine with aura . A meta-analysis revealed that the risk of hemorrhagic strokes was greater in females with any types of migraine and in female migraineurs aged less than 45 years . However, in a recent population-based study, the risk of hemorrhagic stroke increased irrespective of sex or age group . Types of hemorrhagic strokes included subarachnoid hemorrhage and intracerebral hemorrhage . Most of studies did not provide information about the presence of aneurysm. Mechanisms underlying the association between migraine and hemorrhagic stroke are unclear. Although the association is positive in public health aspect, the absolute incidence of hemorrhagic stroke is very low in general practice .

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Is It A Migraine Or Another Type Of Headache

Although many people describe all moderate to severe headaches as “migraine,” there are specific criteria used to identify migraine, tension, and other less-common headache varieties.

One of the differences between headache and migraine pain is that migraine pain has a throbbing quality, and even the slight physical exertion may worsen their pain.

Migraine And Vascular Risk Factors

Hemiplegic Migraines Tied to Stroke

The role of conventional vascular risk factors on the risk of cardiovascular events in people with migraine is controversial. Migraine, and particularly MA, is associated with an unfavourable cardiovascular risk profile and an increased 10-year predicted risk of coronary heart disease based on the Framingham Risk Score. Frequent headache and long-term migraine are associated with a poorer cardiovascular risk profile. Although people with migraine have an increased risk of ischaemic stroke in the presence of vascular risk factors, several studies have shown that the association between migraine and ischaemic stroke is apparent in people with low Framingham Risk Score. The few exceptions were a positive association with family history of cardiovascular disease, cigarette smoking and oral contraceptives. This agrees with reports that coronary and carotid arteries of individuals with active migraine are found to be less severely affected by atherosclerosis than individuals without migraine, suggesting a non-atherosclerotic mechanism behind the MA-ischaemic stroke link.

Clinical implication

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The Differences In Diagnosing Migraine And Stroke

To diagnose migraine, a doctor carries out a number of tests to check vision, reflexes, sensation, and coordination.

It can also be helpful for people to keep a record of any symptoms they experience, lifestyle factors such as diet and sleep, and frequency of migraine attacks. A doctor will also assess any medication people are taking.

To diagnose a stroke or TIA, doctors carry out a range of tests including:

  • MRI or CT scans to provide imaging of the brain
  • electrical impulse tests to show electrical activity in the brain
  • blood flow tests to look for any issues with blood flow to the brain

According to a 2017 article, there are currently no clear guidelines for preventing stroke in people with migraine.

People can take steps to help reduce the risk of stroke through lifestyle changes, such as:

Stroke Or Migraine How To Recognize The Differences In Symptoms

While its always advisable to seek emergency medical treatment by calling 911 for any signs of stroke, even if youre not sure, there are subtle differences in symptoms that may give you a clue as to whether its a stroke or migraine.

Here are some questions to ask that may help you identify:

  • Abrupt or gradual? A stroke typically comes on suddenly, without warning. Symptoms are immediately at peak intensity. A migraine aura usually occurs gradually, with symptoms evolving over several minutes and any accompanying headache building to a peak over time.
  • Increased or decreased vision changes? With migraine you see it, with stroke you dont. Someone having a migraine with aura will experience added visual stimuli, such as flashing lights or zigzagging lines. A stroke, on the other hand, typically diminishes vision bumping into something may be the first clue that vision has been impaired.
  • Past history of migraine? Although its possible to have a first migraine at any age, its more typical to begin having them as a child. Most migraine sufferers will also recognize their aura, as it tends to be the same every time. If you have never had a migraine or your migraine symptoms differ from their normal course, get to the closest ER or urgent care center. With stroke, its also possible to have one at any age or in any physical shape, so dont ever rule it out. Call 911 immediately, because its better to be safe than sorry.

Revised 4/27/2021

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Migraine And Subclinical Brain Lesions

WMH are more frequently found on neuroimaging in migraineurs than in non-migraine population. Earlier meta-analysis provided high odds ratio with 3.90 for having WMH in migraineurs . Recent meta-analysis estimated lower odds and showed the association only in MA, not in MO . Subclinical brain infarcts were found more in migraineurs than in controls, particularly in the posterior circulation . Increased risk of having WMH or subclinical infarcts is associated with increased headache frequency . Longitudinal MRI follow-up studies showed that WMH increase over time in migraineurs . However, large population-based prospective studies failed to document temporal associations between the number of migraine headache attacks and brain lesion progression . Clinical significance of WMH seen in migraine patients is still unclear. Cognitive dysfunction seems not to be associated with WMH in migraineurs .

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