The big unanswered question is “how much of this is genetic?” because that’s not something we as doctors can influence directly through treatment. What further research needs to be done in order to understand a link between migraine and stroke and how to evaluate patients? Women with migraine with aura are at an increased risk for myocardial infarction, needing coronary bypass surgery, needing a heart stent and they have a slightly increased risk of vascular death. And we recently found that risk isn’t just increased for ischemic stroke, it’s for all vascular diseases. At that time, most contraceptives had a much higher estrogen content than they do today, not to say that there is no longer any risk. We observed this in studies that took place about 20 years ago. Some people say that there’s a risk between contraceptive use and stroke, is that escalated in migraine patients? It’s really worthwhile to go to a physician at least once a year for a check up on hypertension, high cholesterol, diabetes, obesity, and other lifestyle factors that may put you at an increased risk for stroke. Instead, they should look for other vascular risk factors present. Women with migraine shouldn’t live in fear of having a stroke because that’s not really the issue. What recommendations can you make for patients with migraine or headache looking to lower their risk of stroke? I would say smoking poses the highest added risk for women who have migraine with aura. It’s just women who have migraine with aura who are at a higher risk, especially if there are any additional risk factors for vascular disease at play, like high blood pressure, obesity and especially smoking. Women with migraine without aura don’t show any significant risks either. Men with migraine with and without aura do not have any significant risk of stroke. So are some patients with migraine or headache more at risk than others? ![]() One question that was addressed in these huge registries was, “Is there a relationship perhaps between migraine and stroke?” As it turned out, there was a relationship, and it showed that women below the age of 45 who have migraine with aura have an increased risk of ischemic stroke. The registry originally was implemented to investigate risk factors for stroke, myocardial infarction, and cancer. It was first observed about 20 years ago when the first large-scale registries were done. Tell us about the relationship between stroke and migraine He recently spoke with the American Headache Society about the unique ways vascular issues like stroke can impact women with migraine with aura. Hans-Christoph Diener, MD, PhD, a Senior Professor of Clinical Neurosciences at the University of Duisburg-Essen in Germany, has been studying headache as it relates to stroke for more than 20 years. There is still much research to be done on the relationship between stroke and migraine, but studies have confirmed that young women with migraine with aura are at an increased risk. ![]() Migraine & Stroke Risk in Women Hans-Christoph Diener, MD, PhD expands on stroke risks specific to women with migraine with aura.
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