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Migraine And Stroke: Perspectives For Stroke Physicians.

T. Kurth, H. Diener
Published 2012 · Medicine

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Migraine and stroke have been linked by numerous individual studies1–4 and 3 meta-analyses.5–7 Advances in pathophysiology have increased our knowledge about potential mechanisms linking migraine with cerebral vascular events.8,9 Overall, there is consistent evidence that individuals with migraine are approximately 2 times more likely to develop an ischemic stroke6,7 and in most studies this association is limited to patients with migraine with aura (MA) and stronger among younger women, particularly if they smoke or/and use oral contraceptives.4,6 It remains unclear, however, how important migraine is when a patient has a stroke. Because migraine is a very prevalent disease with approximately 20% of the general population being affected at least part of their lives,10 it is not surprising that many patients with a stroke have a history of migraine. However, often migraine is not directly linkable to the stroke event and uncertainties remain for the necessity of additional diagnostic workup and for potential therapeutic consequences. Moreover, the interrelationship between migraine and stroke is complicated by the fact that other distinct clinical conditions can trigger a migraine-like attack and that these conditions are stroke risk factors by themselves such as artery dissections.11 In this review, we summarize the evidence linking migraine with stroke, highlight new aspects of this association, and discuss potential mechanisms that are of interest for the management of patients with stroke who have a history of migraine. ### Ischemic Stroke Results of 3 meta-analyses of observational studies5–7 show that individuals with migraine have a 2-fold increased risk of ischemic stroke. In 26,7 this increased risk is limited to patients with MA. The risk seems to increase with increasing migraine attack frequency12,13 and women and younger age …
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