Is Migraine Tied to Ischemic Stroke Among Women?


Women with migraine with secondary, ischemia-induced aura may have an increased risk of stroke, according to a new review published in Headache.

“Although further research is needed, we recommend consideration of a diagnostic evaluation of MWA that mirrors the evaluation of transient ischemic attack, given that prophylactic treatment targeting the ischemic origin of secondary aura may prevent migraine as well as stroke,” the authors of the study wrote.

The researchers arrived at their conclusion after performing a narrative review of epidemiological data on the association between migraine and stroke, as well as arterial, thrombophilic, and cardiac mechanisms that may play a role in this association. Data were obtained from the MEDLINE/PubMed database.

Important findings yielded from the narrative review included:

  • Migraine with aura (MWA) is tied to several risk factors for stroke, including hyperlipidemia, hypertension, cigarette smoking, atrial fibrillation, diabetes, and patent foramen ovale.
  • MWA among women is associated with biomarkers of venous thromboembolism, pregnancy, endothelial activation, and hormonal contraceptive use, which suggests that a subset of auras may be secondary, or provoked by ischemia associated with microemboli or in situ thrombosis.
  • MWA‐associated ischemic stroke occurs most frequently in women younger than age 45 years who experience a high frequency of migraine attacks, are pregnant or have experienced preeclampsia, and use hormonal contraception.
  • Evidence has increasingly indicated that cardioembolism, often in combination with thrombophilia, may be an important factor in MWA‐associated cerebral infarction.

“The commonality of factors associated with MWA and with MWA‐associated stroke suggest that persons with secondary, ischemia‐induced aura may be at elevated risk of stroke,” the researchers concluded.

—Christina Vogt

Tietjen G, Maly EF. Migraine and ischemic stroke in women. A narrative review [published online April 4, 2020]. Headache. doi:10.1111/head.13796