Migraine as a vascular risk factor

Introduction. Migraine and stroke are associated with a higher frequency than expected. Numerous studies have shown a significant, but controversial, association between migraine and vascular disease, not only in cerebral but also in other arterial beds. The full spectrum of this relationship includes coexisting stroke and migraine, stroke with clinical features of migraine and migraine-induced stroke. Why migraine is a risk factor and how it leads to stroke is not entirely understood, possibly because the mechanisms involved are multiple, complex and interrelated. Aim. Emphasizing the most recent papers, we review critically the current knowledge about the causal relationship between migraine and vascular disease and discuss its pathophysiology. Development. Migraine is an independent risk factor for stroke, especially for young women with frequent migraine with aura attacks, who smoke and use oral contraceptives. Migraine has also been associated with lesions in the white matter and in other vascular territories. Potential pathogenic mechanisms include endothelium and vascular smooth muscle dysfunction, hypercoagulability, cortical spreading depression, genetic factors, patent foramen ovale, unfavourable vascular risk profile, arterial dissection and migraine-specific treatment. Conclusion. Considering that cerebrovascular disease is a major cause of disability and mortality and that migraine is a risk factor for vascular disease, understanding the relationship between migraine and vascular disease is necessary to reduce risks and optimize management and treatment.