Interactions between migraine and stroke

  • Jesse Weinberger

Opinion statement

When a patient with migraine has a stroke, all other causes of stroke should be ruled out before the stroke is attributed to migraine. Migraine mimics that present with headaches and stroke, including arteriovenous malformation and cervical carotid artery dissection, should be considered. Patent foramen ovale is a risk factor for both migraine and stroke and should be ruled out with transesophageal echocardiography. A patient with migraine with aura with persistent focal neurologic deficits in the distribution of the typical aura can be diagnosed with migrainous stroke. Patients with migraine with aura with persistent focal neurologic deficits can be treated pharmacologically with intravenous verapamil or magnesium sulfate to relieve the symptoms in familial hemiplegic migraine and sporadic hemiplegic migraine. Prophylactic treatment should be administered to patients with frequent attacks of migraine with aura to prevent recurrence. Oral verapamil is recommended for patients with familial hemiplegic migraine and may be effective in patients with sporadic hemiplegic migraine. Endovascular closure of patent foramen ovale has been reported to prevent recurrence of migraine with aura. The role of patent foramen ovale closure remains controversial pending completion of controlled randomized trials.


Migraine Migraine Attack Main Side Effect Migraine Patient Migraine With Aura 
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References and Recommended Reading

  1. 1.
    Teive HAG, Kowacs PA, Maranhao F, et al.: Leao’s cortical spreading depression. From experimental “artifact” to physiological principle. Neurology 2005, 65:1455–1459. Interesting article on the pathophysiology of migraine from a historical perspective.PubMedCrossRefGoogle Scholar
  2. 2.
    Waeber C, Moskowitz MA: Migraine as an inflammatory disorder. Neurology 2005, 64:S9-S15. An excellent summary of current concepts in the pathophysiology of migraine.PubMedCrossRefGoogle Scholar
  3. 3.
    Kruit MC, Launer LJ, Ferrari MD, van Buchem MA: Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study. Brain 2005, 128:2068–2077. Documentation of ischemic events in migraine patients with MRI imaging.PubMedCrossRefGoogle Scholar
  4. 4.
    Kruit MC, van Buchem MA, Hofman PA, et al.: Migraine as a risk factor for subclinical brain lesions. JAMA 2004, 291:427–434. Documentation of ischemic events in migraine patients with MRI imaging.PubMedCrossRefGoogle Scholar
  5. 5.
    Welch KMA: Relationship of stroke and migraine. Neurology 1994, 44(Suppl 7):S33-S36.PubMedGoogle Scholar
  6. 6.
    Bousser MG, Welch MA: Relation between migraine and stroke. Lancet Neurol 2005, 4:533–542. Important review.PubMedCrossRefGoogle Scholar
  7. 7.
    Rothrock JF, Walicke P, Swenson MR, et al.: Migrainous stroke. Arch Neurol 1988, 45:63–67.PubMedGoogle Scholar
  8. 8.
    Rothrock J, North J, Madden K, et al.: Migraine and migrainous stroke: risk factors and prognosis. Neurology 1993, 43:2473–2476.PubMedGoogle Scholar
  9. 9.
    Diener HC, Weimar C, Katsarava Z: Patent foramen ovale: paradoxical connection to migraine and stroke. Curr Opin Neurol 2005, 18:299–304. Important review of the status of the role of PFO in migraine.PubMedCrossRefGoogle Scholar
  10. 10.
    Schwerzmann M, Nedeltchev K, Lagger F, et al.: Prevalence and size of directly detected patent foramen ovale in migraine with aura. Neurology 2005, 65:1415–1418.PubMedCrossRefGoogle Scholar
  11. 11.
    Anzola GP, Morandi E, Casilli F, Onorato E: Different degrees of right-to-left shunting predict migraine and stroke: data from 420 patients. Neurology 2006, 66:765–767.PubMedCrossRefGoogle Scholar
  12. 12.
    Durcros A, Diener HC, Joutel A, et al.: The clinical spectrum of familial hemiplegic migraine associated with mutations in a neuronal calcium channel. N Engl J Med 2001, 345:17–24.CrossRefGoogle Scholar
  13. 13.
    Thomsen LL, Eriksen MK, Romer SF, et al.: An epidemiological survey of hemiplegic migraine. Cephalalgia 2002, 22:361–375.CrossRefGoogle Scholar
  14. 14.
    Chabriat H, Joutel K, Vahedi E, et al.: CADASIL. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. In Stroke: Pathophysiology, Diagnosis and Management. Edited by Mohr JP, Choi DW, Grotta JC, et al. Philadelphia: Churchill Livingstone; 2004:687–692.Google Scholar
  15. 15.
    Hirano M, Pavlakis SG: Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS): current concepts. J Child Neurol 1994, 9:4–13.PubMedCrossRefGoogle Scholar
  16. 16.
    Yu W, Horowitz S: Familial hemiplegic migraine and its abortive therapy with intravenous verapamil. Neurology 2001, 57:1732–1733.PubMedGoogle Scholar
  17. 17.
    Yu W, Horowitz SH: Treatment of sporadic hemiplegic migraine with calcium-channel blocker verapamil. Neurology 2003, 60:120–121.PubMedGoogle Scholar
  18. 18.
    Vijayan N: Brief therapeutic report: papaverine prophylaxis of complicated migraine. Headache 1977, 17:159–162.PubMedCrossRefGoogle Scholar
  19. 19.
    Bigal ME, Bordini Ca, Tepper SJ, Speciali JG: Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized, double-blind, placebo-controlled study. Cephalalgia 2002, 22:345–353.PubMedCrossRefGoogle Scholar
  20. 20.
    D’Amico D, Grazzi L, Usai S, et al.: Toprimate in migraine prophylaxis. Neurol Sci 2005, 26:S130-S133.PubMedCrossRefGoogle Scholar
  21. 21.
    Lampi C, Bonelli S, Ransmayr G: Efficacy of topiramate in migraine aura prophylaxis: preliminary results of 12 patients. Headache 2004, 44:174–177.CrossRefGoogle Scholar
  22. 22.
    D’Andrea GD, Allais G, Grazzi L, Fumagalli L: Migraine with aura from pathophysiology to treatment: therapeutic strategies. Neurol Sci 2005, 26:S104-S107.PubMedCrossRefGoogle Scholar
  23. 23.
    Fuller GN, Fuiloff RJ: Propranolol in acute migraine: a controlled study. Cephalalgia 1990, 10:229–233.PubMedCrossRefGoogle Scholar
  24. 24.
    Limmroth V, Michel MC: The prevention of migraine: a critical review with special emphasis on betaadrenoceptor blockers. Br J Clin Pharmacol 2001, 52:237–243.PubMedCrossRefGoogle Scholar
  25. 25.
    Baumel B: Migraine: a pharmacologic review with newer options and delivery modalities. Neurology 1994, 44:S13-S17.PubMedGoogle Scholar
  26. 26.
    Hall GC, Brown MM, Mo J, MacRae K: Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice. Neurology 2004, 62:563–568.PubMedGoogle Scholar
  27. 27.
    Combrement PC, Marcus E: Intracranial hemorrhages associated with sumatriptan. Neurology 2001, 56:1243–1244.Google Scholar
  28. 28.
    Scott PA, Silbergleit R: Misdiagnosis of stroke in tissue plasminogen activator-treated patients: characteristics and outcomes. Ann Emerg Med 2003, 42:611–619.PubMedCrossRefGoogle Scholar
  29. 29.
    Homma S, Sacco RL: Patent foramen ovale and stroke. Circulation 2005, 112:1063–1072. A classic review of the diagnosis, management, and treatment of PFO and stroke.PubMedCrossRefGoogle Scholar
  30. 30.
    Reisman M, Christofferson RD, Jesurum J, et al.: Migraine headache relief after transcatheter closure of patent foramen ovale. J Am Coll Cardiol 2005, 45:493–495.PubMedCrossRefGoogle Scholar
  31. 31.
    Giardini A, Donti GA, Formigari A, et al.: Transcatheter patent foramen ovale closure mitigates aura migraine headaches abolishing spontaneous right-to-left shunting. Am Heart J 2006, 151:922.e1–922.e5.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  • Jesse Weinberger
    • 1
  1. 1.Department of NeurologyThe Mount Sinai School of MedicineNew YorkUSA

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