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The high prevalence of migraine among young individuals with stroke as well as dysfunction of cerebral arteries during the migraine attack has led to the hypothesis that migraine may be a risk factor for ischemic stroke. Indeed, initial retrospective case-control studies found increased risk of ischemic stroke, in particular among migraineurs with aura1 and among young women with migraine.2 Recently, a systematic meta-analysis of 14 observational studies showed that the risk of ischemic stroke was increased among all migraineurs (2-fold), migraineurs with aura (2.9-fold), and migraineurs without aura (1.6-fold).3
Is this enough evidence to conclude that migraine is a risk factor for stroke? In fact, a careful evaluation of the existing data raises more questions rather than providing a clear picture. First, most studies lack consistent definitions for migraine. Second, most studies only included younger individuals (aged 45 or younger) leaving the association between migraine and stroke among the elderly unclear and ignoring the fact that migraine may start later in life.
In this issue of Neurology, Stang et al.4 provide further insights into the association between migraine and stroke, as well as migraine and stroke-like symptoms among the elderly. …
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