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Open Access 20-02-2025 | Migraine | Review

Migraine and stroke: correlation, coexistence, dependence - a modern perspective

Authors: Michał Borończyk, Anna Zduńska, Julia Węgrzynek-Gallina, Olga Grodzka, Anetta Lasek-Bal, Izabela Domitrz

Published in: The Journal of Headache and Pain | Issue 1/2025

Abstract

Background

Migraine is a chronic neurological condition that has a well-documented, yet not fully understood connection to stroke, particularly in patients who experience migraine with aura (MA). Although migraine can rarely be directly related to stroke, in the form of migrainous infarction, it serves as an independent risk factor, particularly when combined with other factors such as smoking or hypertension. This study will thoroughly review and summarize the existing literature regarding the relationship between migraine and stroke.

Main text

Several key processes are common to both stroke and migraine. These include cortical spreading depression, particularly in MA, endothelial dysfunction, which activates local inflammatory responses, and vasculopathy, which often appears as white matter hyperintensities on neuroimaging. Furthermore, microRNAs also play a significant role in the pathogenesis of both migraine and stroke by targeting genes such as CALCA, which regulates calcitonin gene-related peptide, a factor involved in the pathophysiology of both conditions. There are also several genetic links between migraine and stroke, including both monogenic diseases and common risk loci. Moreover, various conditions are linked to both migraine and stroke, including patent foramen ovale (PFO), atrial fibrillation, carotid artery dissection, platelet dysfunction, dyslipidemia, obesity, hyperhomocysteinemia, and elevated estrogen levels, such as in combined hormonal contraceptives. Notably, PFO is often found in patients who have experienced a cryptogenic stroke, as well as in those with MA. While microemboli associated with PFO may provoke ischemic events and migraine attacks, the effectiveness of PFO closure in alleviating migraine symptoms has produced varying results. Migraine is linked to worse outcomes after ischemic stroke, including larger stroke volumes and poorer functional outcomes, while the connection between migraines and hemorrhagic stroke is less understood. Furthermore, migraine may serve as a stroke mimic (condition presenting with symptoms similar to ischemic stroke) or a stroke chameleon (unrecognized stroke misdiagnosed as migraine), leading to significant diagnostic and treatment errors.

Conclusions

The interplay between migraine and stroke is complex, involving shared pathophysiology and overlapping risk factors. While migraine can serve as both a cause and a risk factor for stroke, the precise mechanisms remain unclear, warranting further research to clarify their connection and enhance clinical management.

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Title: Migraine and stroke: correlation, coexistence, dependence - a modern perspective
Authors: Michał Borończyk
Anna Zduńska
Julia Węgrzynek-Gallina
Olga Grodzka
Anetta Lasek-Bal
Izabela Domitrz
Publication date: 20-02-2025
Publisher: Springer Milan
Keywords: Migraine
Cerebrovascular Diseases
Migraine with Aura
Migraine-Induced Stroke
Cerebral Ischemic Stroke
Intracranial Hemorrhage
Neurological Diseases in General Practice
Published in: The Journal of Headache and Pain / Issue 1/2025
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-025-01973-w

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Migraine and stroke: correlation, coexistence, dependence - a modern perspective

Abstract

Background

Main text

Conclusions

Other articles of this Issue 1/2025

Offset analgesia as a marker of dysfunctional pain modulation in episodic and chronic migraine

Epidemiology of clinically significant migraine in Israel: a retrospective database study

The burden of migraine and tension-type headache in Asia from 1990 to 2021

Effectiveness and tolerability of rimegepant in the acute treatment of migraine: a real-world, prospective, multicentric study (GAINER study)

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Abstract

Background

Main text

Conclusions

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