Assessing the Connection Between Migraine and Ischemic Stroke

Migraine and ischemic stroke are clinically distinct neurological disorders that share overlapping vascular and pathophysiological mechanisms.Migraine, especially with aura, has been observed to correlate with an elevated risk of ischemic stroke, a relationship that holds significant clinical relevance, especially in younger patients and women with additional vascular risk factors such as smoking or estrogen-containing contraceptive use.The pathogenesis of this connection is multifactorial and not fully described.Some of the suggested mechanisms include cortical spreading depression (CSD), which results in transient cerebral hypoperfusion; endothelial dysfunction that contributes to a prothrombotic state; different cerebrovascular reactivity components; and the possible contribution of paradoxical embolism in patients with a patent foramen ovale (PFO).White matter hyperintensities evident on neuroimaging among migraineurs are additional structural changes that indicate a microvascular component that is chronic. Methods:This narrative review synthesizes the existing literature on the relationship between migraine and ischemic stroke, focusing on epidemiological data, proposed mechanism, and clinical management strategies, including migrainous infarction.This article is intended to assist evidence-based, clinical decision-making that is informed by neurovascular.