Author Response: Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update
RaffaeleOrnello, Neurologist, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Luciano A.Sposato, Neurologist, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
SimonaSacco, Neurologist, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Submitted March 03, 2023
We read with interest the comments by Scutelnic et al. on our Review article.1 Their comments confirm the scientific community's ongoing interest in the association between vascular comorbidities and migraine.
We agree with the comments of Dr. Scutelnic et al. regarding the clinical presentation of migrainous infarction. Migrainous infarction can present with migraine aura symptoms, but typical neurological deficits ensue, leading to the diagnostic suggestion of an ischemic stroke.2 Aura symptoms are transient, positive, and progressive, while typical ischemic neurologic symptoms are negative and reach their maximum soon after the onset of a stroke or transient ischemic attack.3
Differentiating migrainous infarction from usual migraine depends on the difference between aura and ischemic symptoms. We also agree that aura symptoms can change during life. Nevertheless, the clinical characteristics of ischemic and aura symptoms usually allow the differentiation between the two entities.4
Finally, we recognize that the relationship between atrial fibrillation and migraine with aura is complex and can be either direct or indirect.5 However, our review focused on microembolism and its role in migraine and stroke pathophysiology. Other associations between cardiac arrhythmias and stroke risk in patients with migraine were beyond this Review’s scope.
1. 1. Sacco S, Harriott AM, Ayata et al. Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update. Neurology Dec 15 2022, 10.1212/WNL.0000000000201699.
3. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi: 10.1177/0333102417738202
4. Lebedeva ER, Gurary NM, Gilev DV, Christensen AF, Olesen J. Explicit diagnostic criteria for transient ischemic attacks to differentiate it from migraine with aura. Cephalalgia. 2018;38(8):1463-1470. doi: 10.1177/0333102417736901
5. Scutelnic A, Mattle HP, Branca M, et al. Migraine and atrial fibrillation: a systematic review. Eur J Neurol. 2022 Mar;29(3):910-920.
Author disclosures are available upon request(journal@neurology.org).
We read with interest the comments by Scutelnic et al. on our Review article.1 Their comments confirm the scientific community's ongoing interest in the association between vascular comorbidities and migraine.
We agree with the comments of Dr. Scutelnic et al. regarding the clinical presentation of migrainous infarction. Migrainous infarction can present with migraine aura symptoms, but typical neurological deficits ensue, leading to the diagnostic suggestion of an ischemic stroke.2 Aura symptoms are transient, positive, and progressive, while typical ischemic neurologic symptoms are negative and reach their maximum soon after the onset of a stroke or transient ischemic attack.3
Differentiating migrainous infarction from usual migraine depends on the difference between aura and ischemic symptoms. We also agree that aura symptoms can change during life. Nevertheless, the clinical characteristics of ischemic and aura symptoms usually allow the differentiation between the two entities.4
Finally, we recognize that the relationship between atrial fibrillation and migraine with aura is complex and can be either direct or indirect.5 However, our review focused on microembolism and its role in migraine and stroke pathophysiology. Other associations between cardiac arrhythmias and stroke risk in patients with migraine were beyond this Review’s scope.
1. 1. Sacco S, Harriott AM, Ayata et al. Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update. Neurology Dec 15 2022, 10.1212/WNL.0000000000201699.
2. Laurell K, Artto V, Bendtsen L, et al. Migrainous infarction: a Nordic multicenter study. Eur J Neurol. 2011;18(10):1220-1226. doi: 10.1111/j.1468-1331.2011.03364.x
3. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi: 10.1177/0333102417738202
4. Lebedeva ER, Gurary NM, Gilev DV, Christensen AF, Olesen J. Explicit diagnostic criteria for transient ischemic attacks to differentiate it from migraine with aura. Cephalalgia. 2018;38(8):1463-1470. doi: 10.1177/0333102417736901
5. Scutelnic A, Mattle HP, Branca M, et al. Migraine and atrial fibrillation: a systematic review. Eur J Neurol. 2022 Mar;29(3):910-920.