Reader Response: Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update
AdrianScutelnic, MD, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
SimonJung, MD, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Christoph JSchankin, MD, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Submitted January 16, 2023
We read with great interest the review by Sacco et al.1 and generally agree with their findings. However, we would like to outline some limitations. First, the clinical description of symptoms of stroke compared to the habitual migraine aura is limited to two small series: Olesen et al.2 report five patients with previous MA and ischemic stroke and Wolf et al took the symptoms of six patients solely from the charts.3 Therefore, we believe that more emphasis should be put on the lack of data on clinical features of stroke in patients with known migraine with aura.
Second, a change of aura symptoms might occur without it necessarily being a stroke, an issue of enormous clinical relevance that has not been covered by the review. Clinical features that help differentiate a non-stereotypical aura from an ischemic stroke are still unclear. This is of particular importance since even patients without history of migraine with aura often report migraine-like symptoms during ischemic stroke.4 Third, the complex association between atrial fibrillation and migraine has been a little oversimplified not covering issues, such as hypercoagulability, antithrombotics as migraine prevention therapy, and others.5
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. Olesen J, Friberg L, Olsen TS, et al. Ischaemia-induced (symptomatic) migraine attacks may be more frequent than migraine-induced ischaemic insults. Brain. 1993;116 (Pt 1):187-202.
3. Wolf ME, Szabo K, Griebe M, et al. Clinical and MRI characteristics of acute migrainous infarction. Neurology 2011;76:1911-1917.4.
4. Scutelnic A, Kreis LA, Beyeler M et al. Migraine aura-like symptoms at onset of stroke and stroke-like symptoms in migraine with aura. Front Neurol. 2022 Sep;13:1004058.
5. Scutelnic A, Mattle HP, Branca M, et. 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 great interest the review by Sacco et al.1 and generally agree with their findings. However, we would like to outline some limitations. First, the clinical description of symptoms of stroke compared to the habitual migraine aura is limited to two small series: Olesen et al.2 report five patients with previous MA and ischemic stroke and Wolf et al took the symptoms of six patients solely from the charts.3 Therefore, we believe that more emphasis should be put on the lack of data on clinical features of stroke in patients with known migraine with aura.
Second, a change of aura symptoms might occur without it necessarily being a stroke, an issue of enormous clinical relevance that has not been covered by the review. Clinical features that help differentiate a non-stereotypical aura from an ischemic stroke are still unclear. This is of particular importance since even patients without history of migraine with aura often report migraine-like symptoms during ischemic stroke.4 Third, the complex association between atrial fibrillation and migraine has been a little oversimplified not covering issues, such as hypercoagulability, antithrombotics as migraine prevention therapy, and others.5
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. Olesen J, Friberg L, Olsen TS, et al. Ischaemia-induced (symptomatic) migraine attacks may be more frequent than migraine-induced ischaemic insults. Brain. 1993;116 (Pt 1):187-202.
3. Wolf ME, Szabo K, Griebe M, et al. Clinical and MRI characteristics of acute migrainous infarction. Neurology 2011;76:1911-1917.4.
4. Scutelnic A, Kreis LA, Beyeler M et al. Migraine aura-like symptoms at onset of stroke and stroke-like symptoms in migraine with aura. Front Neurol. 2022 Sep;13:1004058.
5. Scutelnic A, Mattle HP, Branca M, et. 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).