RT Journal Article
SR Electronic
T1 Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 10.1212/WNL.0000000000201699
DO 10.1212/WNL.0000000000201699
A1 Simona Sacco
A1 Andrea M. Harriott
A1 Cenk Ayata
A1 Raffaele Ornello
A1 Rodrigo Bagur
A1 Amado Jimenez-Ruiz
A1 Luciano A. Sposato
YR 2022
UL http://n.neurology.org/content/early/2022/12/15/WNL.0000000000201699.abstract
AB Migraine and stroke are highly prevalent diseases with a high impact on quality of life, with multiple epidemiological, pathophysiological, clinical, and prognostic areas of overlap. Migraine is a risk factor for stroke. This risk is explained by common risk factors, migraine-specific mechanisms, and non-migraine-specific mechanisms that have a relevant role in patients with migraine with aura (e.g., atrial fibrillation, paradoxical embolism through a patent foramen ovale). Another important link between migraine aura and ischemic stroke is cardiac embolism. Cardioembolism is the most frequent cause of ischemic stroke and increasing evidence suggests that microembolism, predominantly but not exclusively originating in the heart, is a contributing mechanism to the development of migraine aura. In this review, we discuss epidemiological aspects of the association between migraine and ischemic stroke, the clinical presentation of ischemic strokes in patients with migraine, and the differentiation between migrainous and non-migrainous infarctions. After that, we review migraine-specific and non-migraine-specific stroke mechanisms. We then review updated preclinical and clinical data on microembolism as a cause of migraine aura. In the last section, we summarize knowledge gaps and important areas to explore in future research. The review includes a clinical vignette with a discussion of the most relevant topics addressed.