Migraine natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
Complications
Stroke
The association between migraine and increased risk of subsequent stroke has long been suspected. In fact, migraine with aura is associated with two times increase of ischemic stroke, while migraine without aura was not demonstrated to be linked to an increased risk of subsequent stoke. Although patients suffering from migraine with aura are at a double risk of ischemic stroke, the incidence of stroke remains a rare event particularly among young adults. The risk of subsequent stroke is higher among females and among patients suffering from a high frequency of migraine with aura episodes. Some risk factors that predispose to stroke among migraine patients are smoking, OCP use and genetic mutations.
The link between stroke and migraine is far more complicated than a simple risk or predisposition relationship. Migraine, as well as of stroke, involves changes in the vascular and neuronal structure of the brain. Therefore, it is difficult to differentiate whether stroke is a result of the aura of the primary migraine, or if it results from vascular abnormalities predisposing to both migraines and strokes. Some of the vascular abnormalities that are associated with migraines are AV malformations, moyamoya syndrome, hereditary telengectasia, lupus, antiphospholipid syndrome, cardiac myxoma among other vascular medical conditions.
In addition, the underlying pathophysiology of aura is explained by a synchronized depression of the activity of neurons throughout the cortex of the brain causing not only electrolyte changes but also decrease in the cerebral blood flow. This decrease in the cerebral flow lowers the threshold for ischemic stroke. And vice versa, a decrease in the cerebral blood flow as in the case of hypoperfusion, ischemia or embolism leads to cellular changes predisposing to aura. This adds to the complexity of the association between stroke and migraine, which remains unclear.
Migraine and Cardiovascular Risks
Recent studies have suggested that migraine sufferers may be at increased risk of stroke in later life. A meta-analysis of several such studies published in the British Medical Journal[1] in 2005 appeared to confirm this association, with young adult sufferers and women using hormonal contraception at particular risk. The mechanism of any association is unclear, but chronic abnormalities of cerebral blood vessel tone may be involved. Women who experience auras have been found to have twice the risk of strokes and heart attacks over non-aura migraine sufferers and women who do not have migraines.[2]
Prognosis
Many patients with migraine can relieve pain and reduce frenquency with treatments.
References
- ↑ Tzourio C, Tehindrazanarivelo A, Iglesias S, Alperovitch A, Chedru F, d'Anglejan-Chatillon J, Bousser MG (1995). "Case-control study of migraine and risk of ischaemic stroke in young women". BMJ. 310 (6983): 830–3. PMID 7711619.
- ↑ Kurth, T (2006). "Migraine and risk of cardiovascular disease in women". Journal of the American Medical Association. 296 (3): 283–91. PMID 16849661. Unknown parameter
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